Therapeutic approach to patients suffering ischemia of lower extremities and multivessel disease of coronary bed

FIELD: medicine.

SUBSTANCE: urgent surgery on vessels of a lower extremity involves placing an electrode for transoesophageal atrial temporal pacing (TOTP). That is followed by administering a beta adrenergic blocking agent intravenously in a load dose to achieve a decreased heart rate of ≤ 60 beats per minute. The dose of the beta adrenergic blocking agent is reduced to a maintaining one with preserving a sinus decreased heart rate from 72 to 74 beats per minute for the whole surgery and for 2-3 days thereafter as it may be necessary. The surgical repair of coronary arteries is performed at least 3-4 weeks after the surgery on the vessels of the lower extremities.

EFFECT: therapeutic approach provides preventing minor cardiac output syndrome and other cardiovascular adverse effects accompanying the repair surgeries on the arteries of the lower extremities that enables a coronary artery bypass surgery 3-4 weeks later.

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The invention relates to medicine, more specifically to cardiology, anesthesiology and cardiovascular surgery, and may find application in emergency angiohirurgičeskih operations.

In Russia critical limb ischemia occurs in 100-120 people per 100,000 inhabitants. In 55-90% of patients have concomitant coronary artery disease, which determines 10.4-29.5% of observations the development of cardiac complications after reconstructive operations on the abdominal aorta and lower limb arteries.

More than half of hospitalized patients with obliterating atherosclerosis of lower limb arteries (oank) suffer from coronary heart disease (CHD). According to some authors 92% of patients with critical ischemia of lower limbs (CLI) suffer from coronary heart disease [Eur. J. Vasc Score. Endovasc. Surg. 2007. V. 33. Suppl. 1. P. 1-75; / J. Am. Coll. Cardiol. 2007. V. 50 (17). P. 159-241].

Tactics of treatment of patients with occlusive lesions of the abdominal aorta and arteries of the lower limbs with critical ischemia to this day in the presence of coronary heart disease, angina III-IV functional class remains not fully resolved, are not determined the sequence of correction of the affected arterial basins. Some authors consider that it is necessary to perform simultaneous revascularization of both vascular regions. Thus, some authors initially performed coronary artery bypass grafting (CABG), then recon�tructio abdominal aorta. However, mortality in this group was 18%. The risk of myocardial infarction with single-step operations is extremely high. According to other authors it is advisable first step to perform myocardial revascularization, but in this case, registers a large number of cardiac complications, observed the progression of limb ischemia. Preoperative preparation of these patients, some authors used continuous epidural analgesia. Relief of pain and, as a result, vasodilation positive impact on the overall condition of the patient, myocardial contractility, Central hemodynamics, and reduce the risk of developing cardiac complications.

The traditional approach in the treatment of patients who require surgery for oank with concomitant coronary arteries, is that the first stage is carried out myocardial revascularization, and then perform revascularization of the lower extremities. But absolutely other priorities we have to set in patients with already developed a KINK. The fact is that when seeking medical care for patients with a combination of KINK and coronary heart disease the decision on revascularization of the limb could not be left by the wayside.

According to various estimates the incidence of myocardial infarction after elective operations� on the infrarenal aorta ranges from 5 to 16%. Perioperative mortality in patients with CLI when performing open reconstructive operations on orthopadische segment reaches 5-10%. This debatable question about the order of execution of the renovation of two vascular beds [Eur. J. Vase. Endovasc. Surg. 2007. V. 33. Suppl. 1. P. 1-75; J. Am. Coll. Cardiol. 2007. V. 50 (17). e159-241; Diabetes Care. 2006; 29: 575-580; Diabetes Care. 2004; 27: 2843-2849; Systemic cardiovascular complications in patients with long-standing diabetes mellitus: comprehensive assessment with whole-body magnetic resonance imaging/magnetic resonance angiography. 2009; Apr; 44 (4): 242-50; Arch. Intern. Med. Feb. 28, 2005; 165: 430-435; J. Vasc Score. Surg. 2000; 31 (1 Pt 2): S1-S296; J Surg Vasc Score. 2007; 45 (Suppl 1): S5-S67].

One of the causes of mortality during the reconstructions of the coronary bed is the occurrence of the syndrome of small cardiac output (SMSV), which leads to an increased risk of death and number of postoperative complications, including respiratory and renal failure, neurological effects. In order to cope with this complication require timely prevention and treatment.

The syndrome causes small cardiac output in patients who have an emergency or delayed surgery on the background of multivessel coronary disease, are:

- Original invalidizirovannyh myocardium;

- Low preloading (hypovolemia);

- High postawski (increased SVR);

- Intraoperative myocardial damage;

- Residual nekorregirovannyh pathology of the cardiovascular system;

- Acidosis and electrolyte disorders;

- Arrhythmias;

At risk for the development of SMSW in patients who have an emergency or delayed surgery on the background of multivessel coronary disease, include:

- Elderly patients;

- Patients who have had past heart surgery;

- Patients with ejection fraction of the left ventricle less than 40%;

- Patients with stenosis of the left main coronary artery (LCA) more than 70%;

- Female patients.

Most often the anesthesiologist in their practice, working with patients, which operate about multifocal atherosclerosis, faced with sinus bradycardia (heart rate ≤ 60 / min.), if we exclude the problems associated with Arrhythmology.

This is due, firstly, conducting the anesthesia. Almost all drugs that are currently used for anesthesia (except mononarkoza ketamine) have to a greater or lesser extent cardiodepressivne effect and cause inhibition of cardiac conduction system. Besides, there is suppression of the sympathetic nervous system.

Secondly, with the use of drugs from the group of beta blockers in patients with compromised cardiac background.

With�Etania these two factors often leads to severe bradycardia and hemodynamic instability in the perioperative period in patients with generalized atherosclerosis.

If anesthesia is impossible to refuse, because without it you cannot hold a complex surgery, with the second cause of sinus bradycardia the situation is not so unambiguous.

The founder of the use of β-blockers in patients with nocardioformlike interventions is Dr. Don Poldermans is a well - known researcher in the field of cardiovascular medicine.

In 1999 he published his work on the use of bisoprolol in patients operirovavshy about vascular pathology [Don Poldermans, M. D. et. al New Eng. J. Med. 1999. V. 341. P. 1789-1794].

Don Poldermans is co-author of the editorial, 2005 in the New England Journal of Medicine on the use of β-blockers for nocardioformlike interventions [Don Poldermans, M. D. et. al. New. Eng. J. Med. 2005. V. 353. P. 412-414].

He was also the head of a large randomized study in The DECREASE-V and a number of articles on this topic in 2007-2010. J. Am. Coll. Cardiol. 2007. V. 49, No. 17. P. 1763-1769;.. New Eng. J. Med. 2009. V. P. 361 980-989; J. Am. Col. Cardiol. 2010. V. 56. No. 23. P. 1922-1929].

In his works Don Poldermans showed high efficiency from the use of beta-blockers in the appointment of patients with concomitant coronary artery disease and who will have a big surgery to reduce the risk of cardiovascular events in the perioperative period.

Based on the data of his research, were developed algo�itmy management of patients with cardiac pathology, including in vascular surgery.

So, it would seem that the solution to the problem of preparation of intra - and postoperative management of patients with multifocal atherosclerosis was found.

But on November 23, 2011 Medical center Erasmus (Erasmus Medical Center, Rotterdam, the Netherlands) fired Dr. Don Poldermans for violation of academic integrity. In its statement, the hospital said that Dr. Don Poldermans was sloppy in the collection of data to support their conclusions. In official statements of the medical center Erasmus and the European Association of cardiologists not informed what works and studies were violated.

The activities Don Poldermans in the use of β-blockers in the perioperative period had long been the object of criticism. Thus, one of the most influential medical publications - the journal of the American medical Association (JAMA), the authors point to the risk of early stopping of trials due to identify explicit use of the investigated method. As a basic example is a study of Don Poldermans about perioperative use of bisoprolol in high-risk patients going for vascular surgery. The study was stopped, as the results exceeded the boundaries of a statistical test O brown-Fleming about the benefits of the investigated method. At the time of stopping of the study include art is alleged 266. Planned validity coefficient (RR) was equal to 0.5. The study was received RR of 0.09, which is a very high therapeutic effect. This is incompatible with the expectations of the researchers, as well as with the magnitude of therapeutic effect of β-blockers at tens of thousands of patients with acute myocardial infarction and chronic heart failure (RR of 0.65 to 0.85).

In 2005 P. J. Devereaux conducted a meta-analysis of studies on the use of β-blockers in surgical patients [P. J. Devereaux et al. V. J. M. 2005. V. 331. P. 313-321].

In this paper it is shown that β-blockers significantly reduce the risk of large perioperative cardiovascular events but increase the risk of bradycardia and hypotension.

Between 2002 and 2007, a study was conducted which aimed to shed light on the feasibility of using β-blockers in surgical patients. This work is called the POISE (Perioperative Ischemia Evaluation Study) [Lancet 2008. V. 371. P. 1839-47].

In this study we included 8351 patients with risk of coronary heart disease (CHD) in 190 hospitals in 23 countries. 4174 patients received metoprolol succinate with a target dose of 200 mg/day for 2-4 hours prior to surgery with continued therapy within 30 days after surgery. The second group studied included 4177 patients. It was a placebo group.

Primary outcomes included cardiovascular death, �fatally myocardial infarction, non-fatal cardiac arrest. Secondary outcomes: overall mortality, stroke, myocardial infarction, coronary revascularization, atrial fibrillation, congestive heart failure, hypertension and bradycardia. The results of the 30-day observation showed a significant reduction in the incidence of myocardial infarction (176-4,12%) in the metoprolol group compared with the placebo group (239-5,7%).

On the other hand, in the metoprolol group compared with the placebo group was significant increase in total mortality (129-3,1% in the metoprolol group; 97-2,3% placebo). In the metoprolol group registered a higher number of strokes (41-1%) compared with the placebo group (19-0,5%), and had a large incidence of clinically significant hypotension and bradycardia. The latter explains the higher number of strokes. Out of 60 cases of acute disorders of cerebral circulation, 47 were ischemic etiology, 3 - hemorrhagic and 8 is not installed.

The conclusions from this work were as follows:

1. The use of β-blockers in the perioperative period in patients at risk of CHD undoubtedly reduce the incidence of acute myocardial infarction and other major cardiovascular events.

2. Stop taking previously assigned to β-blockers should not.

3. In patients with newly detected coronary artery disease is not recommended destinations�th β-blockers immediately before surgery.

The conclusions of the authors of this study suggest the need to develop other ways cardioprotection during nocardioformlike operations in patients with coronary heart disease.

A special group of CHD patients are patients suffering from atherosclerosis of the arteries of the lower extremities. As noted above, 92% of patients with critical ischemia of the lower limb have coronary artery disease and treatment of such patients to date not resolved.

Dealing professionally the treatment of patients with lower limb ischemia, particularly if they have coronary heart disease, angina III-IV functional class, revascularization of the lower extremities which was urgent, we have set ourselves the challenge to identify and justify the sequence of correction of the affected blood pools.

The present invention relates to the solution to this challenge angiosurgery.

As a prototype we have taken the method described in the "Surgical treatment of patients with a combination of critical ischemia of lower extremities with lesions of aorto-iliac segment and coronary heart disease" [Pathology of circulatory and cardiac surgery, 1, 2013, pp. 73-76].

The paper presents the results of treatment of 236 patients with critical limb ischemia (CLI) with lesions of aorto-poduslo�tion segment in combination with ischemic heart disease.

The study included those patients who had coronary artery disease in myocardial infarction more than 2 months. and/or stable angina II-III FC, no operations for myocardial revascularization in history. Exclusion criteria from the study were: less than 2 months from the time of myocardial infarction, unstable angina, and any revascularization procedure in history.

Patients were divided into 2 groups:

- In the first of 158 people came in 93, which was performed bifurcation aorta-femoral bypass (BABS), and 65 - due to occlusion them the aortic bifurcation was performed aorto-femoral prosthesis (BABP).

- In the second group of 78 people were executed hybrid intervention: open reconstruction of the arteries below the inguinal ligament and endovascular intervention on the iliac arteries. The patients of both groups were comparable in terms of severity of comorbidity.

Due to the presence of KINK in all patients as the first stage of the operation was performed revascularization of the lower extremities.

The aim of the study was to reduce the risk of development of cardiac complications during surgery and in the postoperative period.

Based cardiac medical history of all patients in the preoperative period were prescribed drug therapy aimed at with�iunie frequency of cardiac complications: statins, acetylsalicylic acid and cardioselektivee beta-blockers (BAB). The duration of preoperative preparation for 7-10 days. Dose for WOMEN were selected under the control of heart rate (HR) - the target was considered 55-60 beats/min. Introduction of beta-blocker continued intraoperatively for the purpose of maintaining a heart rate of 60-70 beats/min. the AD sought to maintain 110/70 mm Hg. article the Dose of beta-blocker was started with 2.5 mg/day of bisoprolol or 50 mg/day for metoprolol with subsequent dose titration to achieve target heart rate. Avoid high doses in early treatment - titrated doses for 7 days prior to surgery. If the patient were relative contraindications to beta-blockers were prescribed minimum therapeutic dose and his selective blocker lf-channels ivabradine at a dose of 15 mg/day, with an absolute contraindication - only ivabradine. In the intraoperative period was administered intravenously izoket in the presence of ischemic ECG changes.

After the operation of critical limb ischemia was treated in all patients. Among patients of the first group one in the postoperative period developed acute myocardial infarction with subsequent development perenlei acute renal failure and to save him failed. Even in 5 patients of this group in the postoperative period developed about�try coronary syndrome with ST segment depression, with no signs of hemodynamic instability. This allowed us to determine further tactics of treatment (in accordance with the recommendations of the all-Russian scientific society of cardiologists and the patients ' condition was stable without additional intervention.

In the second group of patients 4 the postoperative period was complicated by acute coronary syndrome with ST segment depression, with no signs of hemodynamic instability. Their condition was stable through conservative treatment, the development of myocardial infarction have been prevented. Deaths in this group were not.

The study authors conclude that at the present stage, a significant reduction of cardiac complications when performing reconstruction of aorto-iliac segment KINK in patients may be achieved by at least two meropriyatiy: first, reducing the overall surgical trauma - through hybrid operations and, secondly, purposeful, with specified targets cardiodynamic preoperative preparation, which must be not less than 7 days.

The conclusions of this work we believe is justified. However, despite the fact that the authors of all of the above was undertaken, however, have been serious complications, including death from developed in the postoperative�ion period of acute myocardial infarction.

It is widely known that the tactics of treatment of patients with critical ischemia of the lower extremities in the presence of CHD remains very relevant and to date, yet to be finally resolved, the order of correction of the affected arterial basins remains a subject of discussion. On the one hand, KINK urgently needed to arrest the other hand, it is associated with a high risk of heart attack.

As noted above, in randomized trials DECREASE-V, it was shown that prophylactic performing coronary artery bypass grafting (CABG) improves survival rate of patients after elective vascular reconstructions. The risk of fatal outcomes in simultaneous intervention on the abdominal aorta and CABG prophylactic quite high. Thus, we can conclude that sequential or simultaneous execution of CABG and BABS does not reduce the risk of cardiac complications, but rather increases them. At the same time, based on the results of many studies it can be concluded that surgical intervention on coronary arteries may still be pending at the time that you may need to perform other urgent procedures, such as KINK as KINK itself is undoubtedly worsens the clinical course of CHD.

The authors of the method-prototypically performed as a first stage in patients with KINK if they have coronary artery disease revascularization of the lower extremities and showed the possibility of performing these operations although there have encountered serious cardiac complications.

With regard to our proposed tactics of treatment of patients with critical limb ischemia and multivessel coronary disease, this study was carried out almost simultaneously, and the aim was to avoid such complications due to the rigid control of heart rhythm in the course of surgery.

The technical result of the present invention is to reduce the risk of cardiac complications due to the control of heart rate by transmisiones temporary atrial pacing (TPVAX).

This result is achieved in that in the known method, including urgent surgery on the lower extremities and therapy with beta blockers, according to the invention to a patient before emergency surgery on the lower limb vessels in the esophagus set electrode for transmisiones temporary atrial pacing (TPVAX), record the heart rate (HR), a beta-blocker is administered intravenously in a loading dose to achieve bradycardia with a heart rate equal to or less than 60 beats/min, then the dose of beta-blocker to reduce support with preservation of sinus bradycardia with heart rate from 72 to 74 beats/m�n and through the electrode to TPVAX hold such variation at the time of surgical intervention and, if necessary, for 2-3 days after, and surgery for reconstruction of the coronary arteries performed not earlier than 3-4 weeks after emergency surgery on the lower limb vessels.

It is advisable as a beta-blocker to use esmolol when loading dose 500 mcg/kg/min and then decreased it to 100 mcg/kg/min.

Electrode for transmisiones atrial temporary pacing is preloaded into the esophagus, allows you to set target heart rate and is guaranteed to keep the rhythm of the heartbeat within the boundaries of the optimal parameters for patients with coronary artery disease. In addition, it enables the use of pathogenetically substantiated therapy of beta-blockers in the preoperative stage, eliminating the prohibitive risk of bradycardia at induction of anaesthesia and at the time of surgery.

The presence of TPVAX engaged in numerical control, also provides reliable prevention of the syndrome of small cardiac output, which prevents episodes of ineffective hemodynamics, which is the cause of acute coronary syndrome.

Since before surgery in patients, as a rule, there are tachycardia, the introduction of beta-blocker in a loading dose to achieve a heart rate of 60 beats/min, quickly removes it and the subsequent introduction of it at a maintenance dose to heart rate 70-7 beats/min with preserving itself through TPVAX during the entire surgery, and if necessary and in the postoperative period, prevents the development of acute critical bradycardia and thereby exclude serious cardiac complications.

A short period of saturation of a patient's BAB allows to avoid their negative impact on the blood supply to the lower limbs.

The inventive method is illustrated by examples.

Example 1.

Patient M., born in 1948 (64 years), was examined and treated in the cardiovascular Department of the clinic of faculty surgery, Russian state medical University with 11.01.2013 on 28.02.2013 case history No. 719/S. The patient was hospitalized in a planned manner with complaints of pain in the right leg and foot when walking up to 10 meters, paresthesia, coldness of the right foot. Was later joined by pain alone at night.

Considers himself ill with 2011, when there was pain in the right lower limb when walking up to 50 meters. He was treated conservatively, without much effect. Over time the disease progressed. Hospitalized in a planned manner.

The patient is examined: angiography of aorta and lower limb (n/a), echocardiography (ECHOCG), consultation with a cardiologist, neurologist (accis in 2010), after which they were exhibited indications for performing panariagroup brain, taking into account 2 risk factors for Lee performed coronary angiography, respiratory function, Fi�registrationcode.

On the basis of consultation of a neurologist and ultrasonic duplex scanning (duplex ultrasonography) brachiocephalic arteries were exposed indication of panariagroup brain. According to this study revealed: occlusion of the internal carotid artery (ICA) on the right and stenosis of 50-75% in the proximal third of the left ICA; stenosis of 75% of the left vertebral artery (LSA) in the proximal third (90%). Flows: from the right cortical zadnemotornoy artery (PCA) in the right middle cerebral artery (MCA) and anterior cerebral artery (ACA). Etc flows: anterior communicating artery is weak from the left of the pool to the right. Cervico-facial: naturvetarna anastomosis to the right with the filling of the right MCA and right ACA.

According to the results of coronary angiography revealed:

The main trunk of the left main coronary artery (LMCA) stenosis 75-90% at the bifurcation with the transition to the branches;

The anterior interventricular branch (LAD) stenosis 75% of the mouth, diffuse stenosis of 75-90% in the proximal and middle thirds;

The circumflex branch (LCx) stenosis of 99% of the mouth and occlusion in the middle third;

The right coronary artery (RCA): diffuse stenosis of 75% in the proximal and middle thirds and occlusion from the middle third.

Function intersystem flows into the left coronary artery (LCA) and right coronary artery (RCA),

Echocardiography (ECHOCG):

Ejection fraction of the left ventricle (ESimpson) 55%. Mitral, tricuspid insufficiency 1 degree. The posterior wall hypokinesia, akinesia bottom of the basal segment. Estimated pulmonary artery pressure of 39 mm Hg. article

Respiratory function (spirometry):

Mixed violations ventilation capacity of the lungs. Moderate restrictive disorders of ventilation capacity of the lungs. Significant obstructive disorders of the ventilation capacity of the lungs.

Fibrogastroduodenoscopy (FGDs):

Ulcer of the antrum (biopsy). Superficial gastritis. Bulbit. Cicatricial deformity of the duodenal bulb.

Within two weeks held antiulcer therapy. During this time the patient developed clinic critical ischemia of the lower limb on the right. Had pain at rest, mostly at night, requiring the introduction of narcotic analgesics from one to two times a day.

According to aorto-arteriography of the lower limbs (p/n):

Common iliac artery is stenosed to 75%, external iliac artery (PPA) to the right occluded from the mouth, on the left PPA stenosed to 75-90% for.

Common femoral artery (BOTH) occluded during the right.

Deep femoral artery (GBA) to the right is filled through the exchanges.

The superficial femoral artery is occluded (PBA).

The popliteal�Naya artery (PA) occluded on the right.

Anterior tibial artery (PBA), posterior tibial artery (SBA) and small tibial artery (MBBA) with two sides either occluded or not contrastively with marked calcification in their projections.

Diagnosed:

Main: Generalized atherosclerosis (multifocal). Obliterating atherosclerosis of vessels of lower extremities (oank) article III occlusion of the external iliac and common femoral artery on the right. Hemodynamically significant stenosis of the aorto-femoral segment on the left. Critical ischemia of the right lower extremity.

Related: Hypertension (GB) of article III, the risk of cardiovascular complications IV St.. Coronary heart disease. Koronarokardioskleroze: LMCA stenosis 75-90% stenosis of the LAD 75-90%, LCx occlusion, occlusion of the RCA in the middle third. Atypical (asymptomatic) form. State after acute violations of cerebral circulation (cerebral vascular accident) from 2010, occlusion of the right ICA stenosis of 70% left ICA. Ulcers disease stomach and duodenal ulcers, supremacia.

With regard to critical ischemia of the right lower limb and risk of loss decided the first step to perform shunt surgery for aorto-femoral segment.

Preoperative preparation included:

1. Enalapril 5 mg per day - canceled the day before surgery.

2. Statin drugs the patient is receiving until the day of operas�tsii.

3. Aspirin cardio 100 mg per day - was cancelled 5 days before surgery and replaced with low molecular weight heparin (Clexane 80 mg per day) with the transition to a simple heparin (firm Baer) in therapeutic dosage (5 thousand units 4 times a day), including the day of surgery.

Premedication included drugs:

1. benzodiazepine number (fenozepam 1 mg per os in the evening 22 o'clock in the morning and 7 hours);

2. anti-ulcer therapy (omeprazole 20 mg in the evening 22 o'clock in the morning and 7 hours);

3. an analgesic (tramadol 100 mg intramuscularly night - 22 hours), with consideration of pain in the right lower extremity;

Patient 4 February 2013 an operation was performed: "the aortofemoral bifurcation bypass surgery, endoarterectomy from both the deep and superficial femoral arteries, femoropopliteal right. Plastic lower branches superior mesenteric artery".

Upon admission to the operating room, the patient began continuous monitoring of BP and HR. Source barometric indicators of the patient upon admission to the operating room were characterized by moderate hypertension (mean arterial pressure (GARDEN) - 100 mm Hg. article, the target values of heart rate (HR) is 86 beats per minute and relative normovolemia [CVP (Central venous pressure)+7 mmHg. article]. On ECG taken before surgery, and operating according to the monitoring�and myocardial ischemia have been identified.

Before surgery the patient into the esophagus set electrode for holding TPVAX. The patient was put Esmolol dose of 500 mcg/kg/min to achieve a heart rate of 60 beats/min, after which the dose of esmolol was reduced to 100 mcg/kg/min until heart rate was achieved 70 to 72 beats/min. Through TPVAX such heart rate was maintained throughout the operation.

From now until the end of surgery has been TPVAX with a heart rate of 72 beats per minute.

Intervention was performed under combined anesthesia: multicomponent combined anesthesia in combination with epidural blockade by the standard technique.

The patient was carried out advanced hemodynamic monitoring. In addition to monitoring of ECG, direct arterial pressure and Central venous pressure (CVP), pulse oximetry were also conducted dynamic monitoring of pulmonary artery pressure, Central hemodynamic parameters (TF), at the stages of surgical intervention was monitored arterial and venous blood gases and acid-base status (CBS) with their correction.

Amid TPVAX in combination with occasional introductions mezatona in breeding 1,0/200 - 8 ml fractional (during surgery - the operation time 4 hours 10 minutes) and the fluid therapy under the supervision of the indicators Yes pulmonary�ing and jamming pressure of the pulmonary capillaries (ZLC) barometric indicators remained stable and did not require the use of drugs inotropic effects (GARDEN - 90-99 mm Hg. art., CVP+10-12 mm Hg. art., heart rate 72 beats per minute, JLC 10-14 mm Hg. calendar).

Despite the stability barometric indicators, the parameters of the TT to start the blood circulation in the lower extremities was described as severe physical inactivity (cardiac index (SI) - 1,2-1,5 l/min/m2; stroke index (si) - 17-21 ml/m2; the index of total peripheral resistance (IOPS) 5333-3840 Dyne/sec/cm5/m2). These indicators are characteristic of the TT patients with obliterating atherosclerosis of the lower extremities (oank), especially for patients with generalized atherosclerosis.

After starting the blood circulation in the lower limb hemodynamic profile characterized by Narodnaia (SI 3,7-4,8 l/min/m2; MD 31-39 ml/m2; IOPS 2285 Dyne/sec/cm5/m2).

After the operation the patient phenomena sinus bradycardia regressed - HR 65-70 beats per minute, through TPVAX she was monitored and was maintained for the next 2 days.

During surgery on the ECG monitor in the operating ischemic changes of character have been identified. Postoperative indicators of troponin I were within normal limits. On ECG taken in the postoperative period of myocardial damage is not detected.

Was discharged on the 24th day of the postoperative period (the healing of wounds on the left thigh in�orignum tension) in satisfactory condition with recommendations:

1. Continue clamping cardiotropic therapy.

2. Hospitalization for subsequent stenting of the left ICA and perform coronary artery bypass grafting (CABG).

3. Limitation of physical activity (atypical CHD after surgery ABS should turn into typical).

After 3 months in the clinic of St. Petersburg state medical University n. a. Acad. I. P. Pavlov patient underwent coronary artery bypass surgery, which was successful.

Example 2.

Patient B., born in 1941 (68 years) was examined and treated in the cardiovascular Department of the clinic of faculty surgery, Russian state medical University n. a. Acad. I. P. Pavlov with 16.11.2009 on 20.01.2010 years, the case history No. 27525. The patient was hospitalized in a planned manner with complaints of pain when walking up to 10 meters in the left leg and foot, coldness of the left foot, night pain in the left foot, passing lowering of the left lower extremity from the bed.

Considers himself ill with 2008, when there was pain in the left lower extremity when walking up to 50 meters. He was treated conservatively without significant effect. The disease continued to progress. Hospitalized in a planned manner.

The patient is examined: angiography of aorta and lower limb, echocardiography (ECHOCG), consultation with a cardiologist, taking into account the presence of two factors, according to Lee (acute myocardial infarction in anamnesis) underwent coronary angiography, the Consul�the als neurologist, the function of external respiration, fibrogastroduodenoscopy.

According to aorto-arteriography of the lower extremities revealed:

- Stenosis of the common iliac artery and 90% in the middle third of the right and occlusion it all over to the left;

- Internal iliac artery is occluded on both sides.

- External iliac artery stenosed right 75% in the lower third and the occluded left;

- Common femoral artery - jagged right side and jagged on the left is populated from collaterals;

- Deep femoral artery - stenosis of 75% from its mouth on the right and jagged left;

- Superficial femoral artery stenosed 90% in the lower third of the right and stenosed 75% in the lower third of the left;

- Popliteal artery - both sides of irregular contours;

- Anterior tibial artery occluded right and not contrasted left;

- Posterior tibial artery and small tibial artery to the right is jagged, left poorly contractionary.

According to the results of coronary angiography in the patient revealed the following:

- Stenosis of the left main coronary artery (LMCA) 75% in the distal;

- Stenosis of the anterior interventricular branch (LAD) of 50-75% in the middle third;

- Stenosis of the envelope branch (LCx) 25-30% in the distal third;

- Right coronary artery (RCA) - narrow, with diffuse stenosis of 50-75% in Proxim�linen Department.

Type of circulation left.

The ECHO-KG: cardiac Cavity is not expanded. Myocardium: the wall thickness of the left ventricle at the upper limit of normal. Valves without visible pathology, blood flow normal. Areas of violation contractility was not detected. Airway diseases have not decreased, ejection fraction by Simpson 67%.

Respiratory function: Slight restrictive violations ventilation capacity of the lungs. Moderate obstructive disorders of the ventilation capacity of the lungs. Bronchospasm was not revealed.

EGD: Superficial gastritis, bulbit.

Based on clinical data and results of examination diagnosed

Main: Generalized atherosclerosis (multifocal). Obliterating atherosclerosis of vessels of lower extremities (oank) article III Occlusion of the common iliac artery (OPA), external iliac artery (PPA) to the left. Subokklyuziya iliac-femoral segment on the right. Critical ischemia of the left lower extremity.

Related: Hypertension (GB) of article III, the risk of cardiovascular complications 4 degrees. Coronary heart disease (CHD): coronarogenic - and postinfarction cardiosclerosis. Atypical (asymptomatic) form. Chronic obstructive pulmonary disease (COPD) without exacerbation. Chronic gastritis without exacerbation.

Given the patients with critical ischemia of the left �igna limbs and the risk of loss, solved the first step to perform shunt surgery for aorto-femoral segment.

Preoperative preparation of the patient included:

1. The angiotensin converting enzyme (ACE) inhibitors - enalapril 5 mg per day - canceled the day before surgery.

2. Statin drugs the patient is receiving to-day operations.

3. Antiplatelet agents (in-Chief ACC) 100 mg per day. Cancelled 7 days prior to surgery, to be replaced with low molecular weight heparin (Clexane) 80 mg per day, with a simple transition to the heparin the day before the operation, in therapeutic dosage, including the day of surgery.

Premedication included drugs:

1. Benzodiazepine number (Phenazepam 1 mg per os) in the evening at 22: 00 in the morning and at 7: 00.

2. Anti-ulcer therapy (Omeprazole 20 mg) in the evening at 22: 00 in the morning and at 7: 00.

3. Tramadol 100 mg intramuscularly for the night - 22.00 - based pain syndrome in the left lower extremity.

The patient 22 December 2009, an operation was performed: "the aortofemoral bifurcation bypass grafting with femoropopliteal two sides".

Upon admission to the operating room, the patient began hemodynamics monitoring: BP - 140/90 mm Hg. art., heart rate is 82 beats per minute.

After admission of the patient to the operating room he set electrode for holding TPVAX. Then entered a beta-blocker (Esmolol) 500 mcg/kg/min with a subsequent decrease dose to 100 mcg/kg/min.

On ECG taken before surgery, and operating according to the monitor of myocardial ischemia have been identified. During the induction of anesthesia, the patient developed sinus bradycardia (heart rate of 48 beats per minute) with a tendency to hypotension (SBP 65 mm Hg. calendar). Initiated atrial stimulation through TPVAX to heart rate of 72 beats per minute, which lasted during the whole surgery. The frequency of sinus rhythm on the stages of the operation ranged from 46 to 54 beats per minute.

The patient was carried out advanced hemodynamic monitoring, that is, except for monitoring of ECG (rhythm, beat, dynamics of myocardial ischemia), direct arterial pressure and Central venous pressure, pulse oximetry, were also conducted dynamic monitoring of pulmonary artery pressure, Central hemodynamic parameters at the stages of operation, control of arterial and venous blood gases and KOS and their correction. Intervention was performed under combined anesthesia: multicomponent combined anesthesia in combination with epidural anesthesia using a standard procedure.

Amid TPVAX in combination with occasional introductions mezatona in breeding 1,0/200 7 ml fractional (duration of surgery was 6 hours 15 minutes) and holding infusion therapy under the control of pulmonary pressure and JLC barometric pok�indicators of hemodynamics remained stable the need for inotropic therapy was absent (GARDEN 77-96 mm Hg. art., CVP 8 to 11 mm Hg. article, JLC 10-12 mm Hg. article, TPVAX 72 beats per minute), with Central hemodynamics (DH) to start the circulation in the lower extremities had signicant geodinamicheskii profile (SI 1,8-1,9 l/min/m2, MD 25-26 ml/m2, IOPS 3575-4211 Dyne/sec/cm5/m2that is characteristic of patients diagnosed with oank.

After starting the blood flow through the shunts indicators TT was characterized as normotimicheskie type of circulation (C 2,9-3,1 l/min/m2, MD 40-43 ml/m2, IOPS 2234-2555 Dyne/sec/cm5/m2).

After the operation, upon awakening, sinus bradycardia regressed. TPVAX terminated. Own sinus rhythm with heart rate of 68 to 72 beats per minute. The patient was awakened, extubated. Delivered in the house of resuscitation and intensive therapy.

During the operation on the monitor ECG ischemic changes of character have been identified. Postoperative indicators of troponin I were within normal limits. On ECG taken in the postoperative period, no changes. According to ECHOCARDIOGRAPHY after surgery without negative dynamics.

Was discharged on the 29th day of the postoperative period with recommendations:

1. To continue cardiotropic therapy.

2. Hospitalization in the subsequent (quota PMF) to perform coronary �of Antonovna (CABG).

3. Limitation of physical activity.

In January 2010 the patient was re-hospitalized for CABG. 27 January 2010, he underwent bypass heart surgery (ISC+CABG (2)). The operation was successful. Was discharged in satisfactory condition.

To date, the proposed method treated 32 patients with CLI in the presence of all of them coronary heart disease. All patients had a two-storey main arteries of the lower limbs, the rest ischemia of the lower extremities. Simultaneously 12 patients had a confirmed lesion of the left main coronary artery, the remaining 20 - technicalities hemodynamically significant coronary lesion, about which they were operated as the second stage within 1-3 months. Surgery went well, without serious cardiac complications.

Proposed tactics of treatment of patients with CLI and multivessel coronary disease in comparison with known methods has a number of significant differences.

1. Exclude serious cardiac complications when carrying out the first stage of treatment of revascularization of the lower extremities due to the possibility to set target heart rate and is guaranteed to keep the rhythm of the heartbeat within the boundaries of the optimal parameters for patients with coronary artery disease.

2. Enables the use of the pathogen�periodically substantiated therapy of beta-blockers in the preoperative period, eliminating the prohibitive risk of bradycardia at induction of anaesthesia and at the time of surgery, which further reduces the chance of cardiac complications.

3. Ensures reliable prevention of the syndrome of small cardiac output, preventing episodes of ineffective hemodynamics, which is the cause of acute coronary syndrome.

4. Does not require a long active unsafe preoperative preparation by titration of the dose BAB.

5. Allows you to perform complete surgical intervention, associated with the reconstruction of the aorta and major arteries, and not just minimally invasive procedures from the category of hybrid angiohirurgičeskih interventions.

The proposed treatment strategy developed in MCRT jointly with St. Petersburg state medical University n. a. Acad. I. P. Pavlov Federal medical research Center. V. A. Almazov and passed clinically tested in 32 patients at the Department of surgery St. Petersburg state medical University n. a. Acad. I. P. Pavlov with a positive result.

1. A method for the treatment of patients with critical limb ischemia and multivessel coronary disease, including urgent surgery on the lower extremities and therapy with beta blockers, characterized in that the patient before emergency surgery on the blood vessels of the lower�their limbs into the esophagus set electrode for transmisiones temporary atrial pacing (TPVAX), record the heart rate (HR), a beta-blocker is administered intravenously in a loading dose to achieve bradycardia with a heart rate equal to or less than 60 beats/min, then the dose of beta-blocker to reduce support with preservation of sinus bradycardia with heart rate from 72 to 74 beats/min and through the electrode to TPVAX hold such variation at the time of surgery and for 2-3 days after, and surgery for reconstruction of the coronary arteries performed not earlier than 3-4 weeks after emergency surgery on the lower limb vessels.

2. A method according to claim 1, characterized in that as beta-blocker use esmolol when loading dose 500 mcg/kg/min and then decreased it to 100 mcg/kg/min.



 

Same patents:

FIELD: medicine, pharmaceutics.

SUBSTANCE: invention relates to a novel compound of formula

(I)

or its pharmaceutically acceptable salt, possessing properties of the IKKβ and TNFα inhibitor. The compound can be used with an additional therapeutic agent, selected from vincristine, camptothecin hydrochloride (CPT-11), lefunomid, dexamethasone and TNFα. Preferable are compounds of formula (I), corresponding to 2-{5-chloro-2-[(1R,2R)-2-hydroxycyclopentylamino]pyrimidin-4-yl}-N-cyclopropyl-1H-indole-4-carboxamide and 2-{5-chloro-2-[(1R,2S)-2-hydroxycyclopentylamino]pyrimidin-4-yl}-N-cyclopropyl-1H-indole-4-carboxamide.

EFFECT: compound can be applied in the treatment of inflammatory diseases such as rheumatoid arthritis, chronic obstructive lung disease, bronchial asthma, multiple sclerosis and intestinal inflammatory diseases, or cancer diseases, such as multiple myeloma, colon cancer, pancreas cancer and ovary cancer, by IKKβ inhibition.

30 cl, 4 tbl, 2 ex

FIELD: medicine.

SUBSTANCE: invention refers to medicine, particularly to cardiac surgery, and concerns intraoperative coronary spasmolysis. That is ensured by 1-minute by-pass cross clamping of an ascending aorta involving administering nitroglycerol solution 4ml containing nitroglycerol 0.1mg in each ml, into an aortic root.

EFFECT: simple technical performance of the method provides the spasmolysis as soon as possible.

1 ex, 1 dwg

FIELD: medicine, pharmaceutics.

SUBSTANCE: invention refers to a method for producing 2-methylene-1,3-dinitroxypropane. The method involves a reaction of silver nitrate and tris(chloromethyl)acetic acid in the acetonitrile medium. The reaction is performed at heating to 60-70°C.

EFFECT: method enables producing the good yield product from the accessible compound in the comfortable medium as well as reducing the number of stages.

5 dwg, 5 tbl

FIELD: medicine.

SUBSTANCE: pharmaceutical composition contains a therapeutic amount of a sterile isolated chemotactic stem cell product, a stabilising amount of serum and a therapeutic agent for promoting the existing cardiomyocyte function in order to compensate the deprivation of the cardiomyocyte function caused by the cardiomyocyte death.

EFFECT: reducing the number of injuries at the infarction due to preventing the cardiomyocyte loss following the acute myocardial infarction by improving perfusion and preventing apoptosis.

27 cl, 13 ex, 4 dwg, 36 tbl

FIELD: medicine, pharmaceutics.

SUBSTANCE: invention relates to pharmaceutical industry, in particular to application of composition for preparation of medications aimed at secondary prevention of cardiac infarction. Application of composition based on substances, applied in Chinese medicine, for preparation of medications aimed at secondary prevention of cardiac infarction, with composition, based on substances, applied in Chinese medicine, is prepared from composition, which contains Radix Astragali, Radix Salviae Miltiorrhizae, Radix Notoginseng and Lignum Dalbergiae Odoriferae, taken in specified ratio.

EFFECT: composition makes it possible to prepare medication, which is effective for secondary prevention of cardiac infarction, prevents stenocardia, improves coronary blood flow.

14 cl, 8 dwg, 74 tbl, 10 ex

FIELD: medicine.

SUBSTANCE: invention concerns using a pharmaceutical combination of an angiotensin-converting enzyme inhibitor and a pineal hormone for treating ischemic heart disease (IHD) in elderly patients. What is declared is using fozinopril 10 mg 2 times a day at 8.00 am and at 8.00 pm, and melatonin 3 mg half an hour before going to bed once a day.

EFFECT: reducing the length of the therapeutic therapy of IHD in the elderly patients and normalising the state within 12-14 days.

4 ex

FIELD: medicine.

SUBSTANCE: claimed invention relates to the field of biotechnology, namely to the preliminary estimation of the efficiency of the autologic cell material transplantation to stimulate the growth of blood vessels, and can be applied in medicine. Claimed is a method of the complex estimation of the angiogenic potential of progenitor cells in patients with cardiovascular diseases, tested on mesenchymal stromal cells of the adipose tissue (MSC-AT) of patients with ischemic heart disease and including the measurement of content of mRNA and proteins of basic angiogenic factors, produced by the progenitor cells such as the vascular endothelial growth factor (VEGF), the placental growth factor (PIGF), the hepatocyte growth factor (HGF), angiopoetin-1 and angiogenin, the angiogenic activity of total cell secretion products, as well as the estimation of the ability of the progenitor cells to stimulate the vascularisation of subcutaneous Matrigel implants, introduced to immunodeficient mice. As the screening method used is a simpler and more available but less informative method of express-assessment of the angiogenic properties of the progenitor cells, based on the measurement of the angiogenic activity of the total cell secretion products.

EFFECT: invention makes it possible to carry out testing of the autologic cell material obtained from the patients, including those with ischemic heart disease, before transplantation in order to choose the optimal tactics of cell therapy aimed at the stimulation of the growth of blood vessels.

2 cl, 2 dwg, 4 tbl, 4 ex

FIELD: medicine.

SUBSTANCE: skin graft is simulated in laboratory animals on the second experimental day. Dihydroquercetin is administered intragastrically in a daily dose of 5.5 mg/kg from the first day every 46 hours of the experiment.

EFFECT: increasing the skin graft survival in the reduced circulation environment by activating the pre-conditioning process.

1 ex, 1 tbl

FIELD: chemistry.

SUBSTANCE: invention relates to 2-ethyl-6-methyl-3-hydroxypyridinium N-acetyl-aminoethanoate, which can be applied as a neurotropic preparation with anti-hypoxic, neuroprotective, anti-amnestic and vestibular-protective activity.

EFFECT: increase of the compound activity.

8 tbl, 7 ex

FIELD: medicine.

SUBSTANCE: shin muscle ischemia is simulated in laboratory animals on the second experimental day by surgical removal of a portion of great vessels, including femoral, popliteal, anterior and posterior tibial arteries. The ischemia is corrected by the intragastric administration of dihydroquercetin in a daily dose of 5.5 mg/kg every 46 hours of the first 7 experimental days.

EFFECT: effective treatment of the skeletal muscle ischemia by stimulating neoangiogenesis that is proved by laser Doppler flowmetry and morphological analysis.

1 ex

FIELD: medicine.

SUBSTANCE: electrical stimulator comprises a stimulation pulse generator integrated into a sealed dielectric enclosure configured to be handled, and electrodes insulated from each other and connected to the stimulation pulse generator. According to the first version, the electrical stimulator is configured as a shower comprising at least two water pipes connected at an input end and comprising active and passive electrodes at output ends. According to the second version, the electrical stimulator is configured as a shower comprising at least two water pipes comprising active and passive electrodes at the output ends; one pipe is laid coaxially inside the other one and gapped for water passage, whereas the output end between the inner and outer pipe bears the active and passive electrodes.

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8 cl, 10 dwg

FIELD: medicine.

SUBSTANCE: generator comprises an external power supply with a connected microcontroller to two legs of which two n-channel field transistors are connected through L-shaped limiting ground resistors. Two or three light diodes and limiting resistors are connected to the above. Transistor drain circuits are grounded, whereas the generator is directly connected to a personal computer. Through it, pulse-width modulation legs of the microcontroller being integrated into the generator are programmed to vary the voltage by switching in and out the diodes at a required average brightness from 0.1 to 100 cd/m2 for producing a fractal "sweep" pattern or a dichotomous pattern of doubled flicker packs. A flash length makes from 0.1 to 1 ms; a flash interval makes 0.1-1 ms; a flash number in one enclosure is from 3 to 7, and an enclosure number is from 2 to 6.

EFFECT: enables studying of the exposure on the living body parameters, including its visual functions, of a non-uniform light medium characterised by scaling time invariance.

1 tbl, 5 dwg

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to endocrinology and surgery and concerns treating the diseases complicated by organ hypotonia and atonia accompanying diabetes mellitus. That is ensured by administering the preparations of α-lipoic acid 600mg intravenously drop-by-drop once a day for 10 days after a lithotripsy in the patients suffering diabetes mellitus complicated by polyneuropathy and urolithiasis. That is combined with a sound stimulation on a projection of the organ by sound waves at frequency 2.4-3.3 kHz, amplitude-modulated low frequency vibrations at 7-60Hz for 6-20 minutes.

EFFECT: combined exposure provides preventing and treating postoperative atonia and hypotonia of urinary bladder, uterine, intestine in the given group of patients by the effective stimulation of smooth-muscle tissues of this organs.

1 ex

FIELD: medicine.

SUBSTANCE: invention refers to medical equipment and is applicable in treating nervous system diseases. A clip attached to a patient's earlap comprises external and internal longitudinal components, a clasp pin, the first and second metal contacts, the first and second non-metallic electrodes, the first and second metal plates. The external component comprises the first gripping section and a contact section of the first electrode. The internal component comprises the second gripping section and a contact section of the second electrode. The clasp pin connects the external component and the internal component. The first and second metal contacts are provided in the contact sections of the first and second electrodes respectively. The first and second non-metallic electrodes are tangent to the first and second metal contacts respectively by a double-sided adhesive tape. The first metal plate with flat back and front ends is inserted into the internal component extending from the first gripping section to the section of the first electrode. The second metal plate is inserted into the internal component extending from the second gripping section to the contact section of the second electrode and consists of flat front and back ends. The bearing surface of each electrode is mounted on one of the metal contacts and represents a small piece of a ring-shaped cotton pad with an adhesive tape attached from both sides from below. The electrodes contact the patient's earlap.

EFFECT: invention enables stimulating the brain with low-intensity current through the patient's earlap in treating the nervous system diseases.

5 cl, 8 dwg

FIELD: medicine.

SUBSTANCE: there are presented a method and a system for sensing the presence of a personal medical device inside a patient. The method involves analysing the patient's image data with the use of a medical device unit and sensing the presence of the personal device inside the patient. The detected medical device is classified. That is followed by receiving the first set of the patient's data with the use of the medical device unit on the basis of the classified personal medical device by inquiring the first data base with the use of the medical device unit. The first set of data involves the type of the personal medical device. On the basis of the first set of data, the second patient's data base is inquired to receive the second set of the patient's data. The second set involves the properties of abatement of the personal medical device. The medical device unit is used to vary the medical procedure in response to the first and second sets of the patient's data. The system involves the medical device unit comprising a machine-readable carrier comprising a logic configured to implement the method.

EFFECT: using the invention provides the reliable operation of the personal medical device in performing medical visualisation procedures.

11 cl, 5 dwg

FIELD: medicine.

SUBSTANCE: invention refers to medical equipment, namely to gastroenterostimulators for the early postoperative recovery of the gastrointestinal motor functions. An apparatus for electrical stimulation of the gastrointestinal tract comprises a step-down transformer with an electrical isolation of primary and secondary windings; a power indicator; an attenuator having three stimulation current control steps; a stimulation current indicator; a stimulation rhythm indicator; a switching unit supplying an electrical stimulating pulse into the oral cavity during chewing. A gastrointestinal motor function stimulation unit represents a rubber brick made from toxically safe chewable rubber. The rubber brick comprises paralleled hermetic micro-switches supplied from an output of the attenuator. On the periphery of the rubber brick, there are mounted silver terminals supplying electrical stimulating pulses onto a bioobject. Every time the gums press the rubber brick when chewing the micro-switches are closed and thereby supply power onto the external terminals arranged on the periphery of the rubber brick and electrically stimulate the patient's oral cavity in time with the chewing reflex rhythm.

EFFECT: providing the early postoperative motor functional recovery of the gastrointestinal tract.

1 dwg

FIELD: medicine.

SUBSTANCE: method involves the ultrahigh-frequency exposure (UHF therapy) in treating pneumonia. The procedure is preceded by determining the blood clotting time. If the blood clotting time is less than 2 minutes, the UHF therapy length is more than 15 minutes daily with the therapeutic course of 8-10 sessions. If the blood clotting time exceeds 6 minutes, the UHF therapy length shall not be more than 3 minutes, 3-4 times a day at the time intervals of min. 30 minutes; the therapeutic course is 25-30 sessions. If the blood clotting time falls within the range of 2 to 6 minutes, the UHF therapy length is 10-12 minutes daily with the therapeutic course of 8-10 sessions.

EFFECT: method prevents the blood hypo- and hypercoagulation, microcirculation disorders in the area of an inflammation causing the delayed clinical course of the disease, the onset of pneumofibrosis and the progressing chronic bronchopulmonary pathology.

2 ex

Treatment // 2530754

FIELD: medicine.

SUBSTANCE: group of inventions relates to medicine. A device contains positive and negative electrodes, a power source and control means. The electrodes are installed or printed on a petal. The power source and the control means are located in a mould depression. The power source is connected to the electrodes by a conductive track. The conductive track of the positive electrode is separated from the negative electrode by an insulating strip. Insulating tracks are located on the petal edge. The method is realised with the application of the said device. In the process of its realisation stimulating electric impacts, sufficient to cause isometric muscle contraction, are supplied.

EFFECT: group of inventions increases the efficiency of a stimulating impact due to the prevention of electric current leakage and proportional increase of the blood flow in tissues.

7 cl, 2 tbl, 26 dwg

FIELD: medicine.

SUBSTANCE: invention refers to medicine, prevention of various diseases, treatment and rehabilitation of humans and animals. The body is exposed to an air medium artificially changed in relation to the ambient medium with using air ions or aerosols in a combination with exposure to an electron flow by at least one negative electrode contacting the human body. Current intensity is specified within up to 50 mA, while a frequency is from 0.00 to 1.7×1015 Hz. A contact point of the negative electrode to the body is coated with a drug or a biologically active substance. The body can be additionally grounded with at least one ground electrode; the body is additionally exposed to electromagnetic waves at a frequency specified from 0.00 to 1.7×1015 Hz.

EFFECT: method provides effective body health improvement by reducing a deficiency of electrons and negative ions, a quantity of free radicals, positive charges in the body, activated blood circulation and metabolism, ATP synthesis, optimised internal environment, including its acid-base state.

4 cl, 1 dwg, 9 ex

FIELD: medicine.

SUBSTANCE: magnetic anastomosis is formed between the adducent and abducent parts of the small intestine with the application of magnetic dies. After formation of the magnetic anastomosis the stoma area is subjected to an impact of impulse laser radiation with a frequency of laser impulse repetition of 5 Hz, 50 Hz and a variable frequency of 0-250 Hz for 60 sec at each frequency. After formation of the anastomosis and coming off of magnetic dies, intestinoscopy with further magneto-laser impact in the zone of the formed anastomosis is performed with a value of a magnetic field induction 30-40 mT and power of infrared radiation in an impulse of 8-50 W for 60-120 sec. A cryo-electrostimulating impact on reflexogenic zones in the intestine projection is realised. Simultaneously a magnetic, an impulse-laser impact and an impact with incoherent radiation of infrared light diodes is realised on the anterior abdominal wall in the area of the navel, right iliac region, right mesogastric region, epigastrium region and left mesogastric region with a frequency of laser impulse repetition of 5 Hz, 50 Hz and a variable frequency of 0-250 Hz with radiation power 8-50 W in an impulse and an induction value of 30-40 mT for 30-60 sec. Deleting of the stoma, sewing the tube in an end-to-end way and its submergence into the abdominal cavity are carried out.

EFFECT: method makes it possible to increase efficiency of recovering functions of the intestinal tube in case of the short bowel syndrome due to acceleration of reparation improvement in the anastomosis zone, recovery of secretary function and suction function in abducent parts of the intestine, reflex enhancement of peristalsis.

2 ex

FIELD: medicine, pharmaceutics.

SUBSTANCE: invention refers to pharmaceutics, namely represents pharmaceutical formulations containing 9-cis-retinyl esters in a lipid excipient. The pharmaceutical formulations containing 9-cis-retinyl esters are described to be applicable in a retinoid replacement therapy for treating retinal degenerations in individuals.

EFFECT: using the formulations for the retinoid replacement therapy for treating retinal degenerations in individuals.

73 cl, 14 dwg, 2 tbl, 6 ex

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