MY MEDICAL^blog

Treatment of pulmonary edema (NL). General Provisions Treatment of pulmonary edema (AL) is directed primarily to a possible normalization of the hydrostatic pressure in the vessels of the ICC. Therapy is aimed, 1 / to suppress foaming, DG 2/korrektsiyu secondary disorders (increasing from ⇒⇒⇒

Modern cardiology is impossible without studying the processes at the molecular and submolecular levels. Only thanks to modern methods of thin study was made possible breakthroughs in science such as bio-energy of the heart. One of the functions inherent in all living things, - ⇒⇒⇒

Arterial hypertension (AH) -prolonged increase in blood pressure (BP)> 140/90 mm Hg. Art .- one of the most frequentchronic diseases are easily identifiable and treatableeffective treatment. At the same time, arterial hypertension- The greatest in history ⇒⇒⇒

? Ostoperatsionnom period.  Results of the study of untreated segments showed that they are characterized by  the absence of any significant changes in the dynamics. As evidenced by our data, in the treatment of segments with various degrees of violations  perfusion before the operation of regional perfusion was significantly increased in most  degrees under load than the rest. Thus, in areas of introduction of CD 133 + cells  was an increase in myocardial reserve only in those segments where there  reduction in perfusion during exercise. In untreated segments of the significant changes  in myocardial reserve after cellular cardiomyoplasty, we did not observe.  The increase in myocardial reserve allows us to explain a significant increase in  tolerance to physical stress and improve quality of life of patients after  operations. is also of interest and the time within which the observed changes  regional perfusion in the treatment of segments with initially reduced perfusion. Improving  perfusion with a load held progressively during the first 6 months after  cell injection and became significant over six months after the intervention. purpose of the study - a demonstration of safety, as well as evaluation  effectiveness of the method. Obtained as a result of research data  allow us to conclude that the use of autologous YASK for the treatment of heart failure is safe.  None of the patients had no complications associated with aspiration of the bone  brain. Given the small number of observations, as well as the lack of a control group,  results can not fully prove that transplantation of autologous progenitor cells  CD 133 + improves myocardial perfusion. The possibility exists that such  segments can occur spontaneously improved. However, no change  in myocardial perfusion in areas remote from the zone of cell exposure  and revealed a significant improvement of myocardial reserve in segments exposed to  effects, combined with the positive dynamics of clinical, indirectly demonstrating  presence of a positive effect on the procedure of autologous transplantation of stem  cells - endothelial precursors (CD 133 +). However, for the final evaluation of the effectiveness, benefit-risk ratio method  cellular cardiomyoplasty, in its further development requires long-term  results of observations and a prospective, randomized studies.   Thus: 1. The results of using autologous bone marrow progenitor cells  CD 133 + in patients with coronary heart disease and idiopathic dilated cardiomyopathy have demonstrated  safety procedures for cell "cardiomyoplasty"   2. After transplantation of autologous progenitor cells CD 133 + reliably  improves myocardial perfusion at a load ranging from 6 months after intervention  in the "treatment" segments with initially moderate, substantial and severe  reduced perfusion. The "untreated" segments of perfusion does not change   3. After the isolated intramyocardial injection of autologous progenitor cells  CD 133 + had significantly improved perfusion in the "treatment" segments  with initially moderate and a significant decrease in perfusion, compared with intracoronary  way of introducing   4. Improved local and global myocardial contractility, clinical and hemodynamic  indicators following the introduction of autologous progenitor cells CD 133 + possible  indicates that stimulation of regenerative processes in cardiomyocytes both in  ischemic and dilated cardiomyopathy in   5. The introduction of autologous stem cells - precursors (CD 133 +) was significantly  improves quality of life in patients with heart failure Application Clinical observations of autogenous YASK with CH Observation 1. As a demonstration of a clinical case presented  VA patient data, 66 years from diagnosis: coronary artery disease. PICS (q - forming them from 2001,  2002). FC IV angina (according to CCS). Constrictive coronary atherosclerosis  (LCA, PMZHV, DV, OM, RCA). Aneurysm of the left ventricle. NC FC III to NYHA. Ventricular premature beats  3B by Lown. Hypertension 2st., Risk 4. ECG : sinus rhythm, HR = 64/min. Deviation EOS left =- 300. Part Time  PVLNPG blockade. PQ-0, 16, QRS-0, 12, QT-0, 40. Cicatrices on the back  LV with the transition to the top and sides. echocardiogram : PL-4, 8 cm, left ventricle: CSR-95 mL, EDV 190 mL, EF = 48%. Mitral valve:  FC-32mm, sash are sealed on the free edge, flexible, multi-directional movement,  regurgitation 1.5 +. Ascending aorta -3.7 cm Aortic valve: tricuspid,  regional fibrosis of the valves. Blood flow was not changed. FC-24mm. Regurgitation is absent.  Tricuspid valve: valve thin, multi-directional movement, FC-33mm.  Regurgitation of the valve 1.5 +. The right to secede is not extended. Design pressure  in the right ventricle 40 mm. Hg. Art. IVS thickness: 1,5 cm thickness ZSLZH: 1,5 cm  Additional features include: additional trabeculae in LV cavity. Conclusion:  Marked hypokinesis posterior - the lower segment, the middle third of moderate hypokinesia.  Mitral insufficiency 1-2 tbsp. Moderate hypertrophy of left ventricular myocardium. Holter : During the study recorded  sinus rhythm with a mean heart rate 63 beats / min. Max. 86ud/min min. HR 1954 at 23:24.  Ventricular ectopic activity is presented in the form of polymorphic ventricular 3,716  extrasystoles, 5 episodes bigemeny. Ventricular extrasystolic activity  predominates in the daytime. Pause and coronary dynamics of the ST segment is not revealed. Treadmill test : The study was conducted on the protocol Vasce. Mastered a  stage - 2 minutes 43 seconds. The sample is suspended in the third minute in connection with  appearance of anginal pain, frequent ventricular extrasystoles. On the ECG ischemia -  changes were observed. Conclusion: The test was positive. Low threshold tolerantsii  physical stress. coronary : The right type of myocardial perfusion. PMZHV - diffuse  defeat all over, calcification, stenosis in the proximal third and middle  third 75%. 1 st and 2 nd septal branches - up to 65% stenosis in the mouth. OM departs from  PKA - up to 75% stenosis in the mouth with a diffuse lesion throughout. PKA -  calcification of the PCA stenosis in the proximal third 60%, after a discharge of OB - occlusion  with partial recanalization of the border proximal third and middle third of PKA  Direct filling of distal RCA and collateral filling ZMZHV  from the system PMZHV. myocardial scintigraphy : Symptoms of an aneurysm in the basal segments  back and rear - the side walls, the apex of LV (area of damage 13-15%).  There have been profound changes in the scar area posterior wall (middle and apical  segments), posterior - lateral wall (middle segment). The total area of scar  changes, including an aneurysm 25%. Viable myocardium in the area of scar  changes is determined in the posterior - lateral wall (apical segments),  posterior IVS (basal and middle segments) and tops adjacent to the front  wall of the left ventricle. Myocardial contractility is reduced, EF 32%. Positron emission tomography : pronounced hypometabolism  glucose in the apex and posterior wall (middle and basal segments) (aneurysm).  Moderate hypermetabolism in the posterior IVS (middle segment), which indicates  about the presence of gibernirovannogo infarction. 24.06.04g patients underwent surgery intramyocardial injection 2.0  million allocated from the bone marrow punctate cells - precursors of CD 133 +. Figure 32. Autologous progenitor cells of CD 133 + (immunocytochemistry  83-87%) technique of the operation : Initially, the patient was performed  Selective coronary angiography, and then retrograde catheterization of the left ventricle, left ventriculography.  Produced a change of catheter and under the control of flyuroskopicheskim in LV cavity held  7F Gaid catheter tip which has been established in the posterior basal portion of LV  in the projection of circumflex artery. In Gaid catheter installed flexible needle with limiter  vkola 0.3 mm for intramyocardial punctures. Completed flyuroskopichesky control  intramyocardial position of the tip, the introduction of suspensions of autologous progenitor cells  CD 133 +. Further, as described above, clockwise procedure was repeated  every 25 degrees with a partial seizure of diaphragmatic and apical region  LV. Total number of punctures 7, volume of injected cell material 2 million. Final  stage was the LVG. The procedure went without complications, arrhythmias were not recorded. postoperative course was uneventful, the patient was discharged on the third day  postoperative intramyocardial injection of autologous stem cell precursors  CD 133 +. To date, the total observation period of 1 year. Subjectively  patient noted significant improvement in clinical condition: a transition to more  favorable class of angina pectoris (from IV to II) for CCS, improvement  quality of life (on all scales of SF - 36). According to the echocardiogram: PL-4, 7 cm  Left ventricle: CSR-80 mL, EDV 175 mL, EF = 54%. The dynamics observed improved kinetics  in the lower apical segment in the middle third - moderate hypokinesia. During  treadmill test indicated a significant increase in the threshold of tolerance to physical  load protocol Basce (from 50 to 125 W), age submaksimum heart rate achieved  without ECG criteria or subjective symptoms of ischemia, rhythm disturbances as a frequent  ventricular arrhythmia, previously identified are not registered. 3 months after surgery no significant dynamics of perfusion or metabolism  not marked. However, a 6-month marked a positive trend  According to positron emission tomography: indicators of accumulation of glucose in  of the back wall slightly increased (Figure 34). In the dynamics (through  1 year) according to SPECT: scintigraphic evidence of an impairment of perfusion in the area  rear - the side wall and rear wall (all levels) with the transition to the top,  related scarring in that area. Gibernirovanny myocardium  determined mainly in the apex and apical posterior segments  - The side wall. Area cicatricial lesions within 25%. Compared with the data  At 6 months of research into the dynamics of positive dynamics in terms of  moderate increase in the accumulation of radiotracer in the area of perfusion defect and some  reduce the size of perfusion defects (from 45% to 39%). Figure 34. Synchronized with the ECG single photon emission  computed tomography (syn-SPECT) with 99m Tc - tetrofosminom and PET  with 18FDG in patients before surgery and VA at 1 year after surgery Observation 2. Patient K., a man, 20 years old. Diagnosis: idiopathic dilated  cardiomyopathy. Mitral insufficiency of 2-3 degrees. Failure  tricuspid and aortic valves of 1 degree. Marked reduction in contractile  LV function (LVEF 24%). Continuously retsediviasyuschaya VT. NC FC IV of NYHA. echocardiogram : PL 52mm, CSR 295 ml/m2, EDV 394 ml/m2, EF 24%. Failure  MC 2-3 degrees. Lack of TC and AC 1 degree. Diffuse hypokinesia, and expressed  hypokinesis posterior - lateral wall, apical region. Selective coronary angiography : The right type of myocardial perfusion. Hemodynamically  significant stenoses of coronary arteries do not. Systolic-diastolic variations of LV  dramatically reduced. Diffuse hypokinesia. EF 25%. 52% of myocardial hypokinesis, 28% -  in akinesia. myocardial scintigraphy (at rest) : A marked reduction in accumulation of radiotracer  on top, front - side, rear wall and upper third of the interventricular  partitions. PET : Signs of a diffuse decrease of glucose metabolism throughout the myocardium. 25.08.04g at the time of coronary angiography patients underwent isolated  intracoronary administration 1.0 h106 autologous stem cells - precursor  CD 133 + in a system of PCA and PMZHV, with the simultaneous creation of a coronary occlusion  sinus (30 seconds) to slow the blood flow to improve penetration  cell injection. postoperative course was uneventful, the patient was discharged on day 6  after surgery intracoronary administration of autologous stem cell precursors  CD 133 +. To date, the total observation period of 1 year. Subjectively  patient noted significant clinical improvement: reduced FC  in NYHA c IV for II-III, improved quality of life (on all scales  SF - 36). These echocardiogram at 6 months p / o: CSR 225 ml/m2, EDV 360 ml/m2,  EF 36%. Lack of MC 2-3 degrees. Lack of TC and AC 1 degree. Diffuse  hypokinesis. 3 months after surgery no significant dynamics of perfusion or metabolism  not marked. However, by 6 months of positive dynamics of the data  myocardial scintigraphy: Radionuclide computed tomography was carried out by  Protocol: 75W - the sample has not been brought to the diagnostic criteria for discontinued  with an increase in breathlessness. Pain in the heart were observed, and coronary dynamics  ECG was not detected. LV increased significantly in size, its cavity is dramatically expanded.  Marked reduction in accumulation of radiotracer (load and at rest) at the apex,  anterior wall (apical segments), side and rear walls (all over).  Zone of destasction - 39%. Compared with the study of the dynamics of 3 months after  A modest operation polozhitelnaya dynamics in terms of: promoting tolerance  physical stress, reduce the size of perfusion defect (50% -39%), increased  accumulation of radiotracer in the area of perfusion defect (mainly on the front wall,  apex, apical segments of the posterior wall). Figure 35. Synchronized with the ECG single photon emission  computed tomography (syn-SPECT) with 99m Tc - tetrofosminom patient  C. prior to surgery and 6 months after surgery Observation 3. Patient S., aged 40, with the diagnosis: The state after the plastic  mitral valve (a rectangular resection of the posterior mitral valve) of 2001.  DCM. The relative failure of the mitral and tricuspid valves  2-3 degrees. Marked reduction in contractile function of LV (EF 21%).  Paroxysmal atrial fibrillation. FC III to NYHA, NC 2A. ECG : sinus rhythm, HR = 78/min. Deviation EOS left. Incomplete blockade  LNPG. PQ-0, 16, QRS-0, 12, QT-0, 40. Signs of left ventricular hypertrophy. echocardiogram : PL 51 mm, CSR 342 ml/m2, EDV 444 ml/m2, EF 21%. FC MK - 44mm,  leaf thin, flexible, multidirectional movement, lack of 3 +. FC  AK 24mm, 3-clack, marginal fibrosis of the valves, blood flow is not changed. FC TC  43mm, fold thin, flexible, multidirectional movement. The degree of regurgitation  to 2. Extended the right to secede. Conclusion: DCM. Reduced contractility  infarction. Diffuse hypokinesia. The relative failure of the mitral and tricuspid  valves 2-3 degrees. Pronounced diffuse hypokinesis. Selective coronary angiography : The right type of myocardial perfusion. Hemodynamically  significant stenoses of coronary arteries do not. LVG: The sharp decline cistolo-diastolic  vibrations of all parts of the heart. myocardial scintigraphy at rest : A moderate reduction in perfusion in  posterior wall of the transition to the posterior-lateral and tip. Expressed total  reduction in systolic thickening. 06.06.05g operation was performed intramyocardial injection of autologous h106 2.0  Stem cells - precursors (CD 133 +) in the back wall of the transition to  posterior-lateral and apical region. technique of the operation : There have been consistent (clockwise  arrow), intramyocardial injection of autologous stem cells in CD 133 +  IV and V segments. The total number of punctures, 5 to 0.35 ml in the general Scope PRA introduced  1.8 ml of cellular material. The final step was carried out LVG. Procedure  took place without complications, arrhythmias were not recorded. postoperative intramyocardial injection of autologous stem cell precursors  CD 133 +. To date, the total observation period of 3 months. Subjectively  patient noted significant clinical improvement: reduced FC  in NYHA c III to II, improvements in quality of life (on all scales questionnaire  SF - 36). These echocardiogram: PL-4.8, LV: DAC-8, 4 cm, the RIC-9, 9cm, PV-31%. During  treadmill test indicated an increase in the threshold exercise tolerance  Protocol Basce (from 50 to 100 watts) achieved age submaksimum heart rate, pain  the heart, shortness of breath, arrhythmias have been reported. According scintigraphy LV : At 3 months after the operation notes  positive trend in terms of moderate reduction of perfusion in the posterior wall  all levels with the transition to the posterior-lateral and apical region of the left ventricle. Level  accumulation of radiotracer in the area of perfusion defect increased by 7% in the treated segments. Figure 36. Synchronized with the ECG single photon emission  computed tomography (syn-SPECT) with 99m Tc - tetrofosminom patient  S. preoperatively and 3 months after surgery. Scientific Center of Cardiovascular Surgery   Russian Academy of Medical Sciences   CJSC "Rehabilitation   medical technology "   info@remetex.com ⇒⇒⇒

conducted in the 70's massive survey                  population showed that about 95% of individuals with elevated blood                  pressure (BP) suffer from essential hypertension (hypertension                  disease), and the ⇒⇒⇒

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most unfavorable occupations                                    in terms of Cardiology, are those in                                    combining                                    a) small physical ⇒⇒⇒

I receive many letters asking to tell                                    the impact of sport and physical education at heart.                                    However, thinking about this subject, I found it necessary to                                    broadened ⇒⇒⇒

at. All of this source of cholesterol,                                  In addition, these products degrade the property of blood,                                  increasing its clot and cause carbohydrate                                  exchange. Should be included in a diet specific                                  amount of liquid vegetable oils, but not                                  get involved! This moment is for some reason, sounds bad                                  in popular recommendations - the so-called excess polyunsaturated                                  fatty acids contained in vegetable oils,                                  may lead to lower HDL                                  density (remember, they have protivoskleroticheskoe                                  action). Another important point, which is also                                  often overlooked: it is necessary (if no contraindications                                  of course) the inclusion in the diet of flour products                                  meal. Contained in the shells of grain                                  Cultures matter how it turned out very well connected                                  cholesterol contained in food (andmoresevere                                  metals, nitrates and nitrites, carcinogens and other                                  nobody wanted "stuff") and output                                  it from the body through the intestine. (When we are                                  disassemble dasgs that reduce cholesterol, you                                  know that there are dasgs - anion                                  resin - acting similarly, but with a large                                  number of side effects and low efficiency).                                  Unfortunately, for a long time it was thought that these                                  substances are only food ballast,                                  so all the technological processing of grain                                  was (and still is) aimed at removing                                  membranes (alas, but the farm. industry virtually                                  not paying attention to this - I still know                                  only two preparations containing these substances).                                  The diet should meet the needs of the organism                                  vitamin B6, which is actively involved in the processes                                  lipid metabolism, transport and decay of cholesterol                                  as well as organic iodine, which increases                                  synthesis of thyroid hormones and thus                                  stimulates recycling of lipids. C                                  this purpose, recommends the inclusion in the diet foods                                  Sea (for those. to whom it is available): dishes                                  seaweed, squid, scallops,                                  mussels, etc.                                  In diet of all cardiac patients                                  profile requires the restriction of salt                                  (Sodium ions) and the inclusion of foods rich in                                  salts of potassium (baked potato, green onions,                                  parsley, dill, black currant, from                                  more exotic - apricots, dried apricots, figs, pasnes,                                  apricots, bananas, a lot of potassium contained in the grains                                  coffee (not instant coffee) and in leaves of black                                  tea). Important reduction in the number                                  sugar, flour and pasta, egg                                  egg yolks (nomorethan 2-3 per week). Recommended                                  included in the diet and oat cereals,                                  soy foods, vegetables, yogurt (without jam).                                  Not recommended for grapes and grape juice,                                  and virtually all other fasits are completely appropriate.                                  It is highly recommended to distribute rations to more                                  number of meals (up to 5-6 times a day).                                  This is called Nibbling and its advantages                                  There is a mass of scientific papers. The latter technique                                  food must be no later than 18-19 hours. Recommended                                  Eat 2.4 sour-sweet apples (you can                                  and after 18). And once that is prohibited:                                  fatty meats, fish, hard meat broth                                  Beef, mutton, pork fat, internal organs                                  animal brains, eggs, bacon, cream, pastries, cakes                                  cream, spicy, salty, fatty snacks, cocoa,                                  chocolate, ice cream, alcoholic drinks.                                  Generally, the diet in atherosclerosis could be                                  would not read a single lecture, but it's time we had already                                  move on to the proper treatment. I can only say                                  that the diet appointed for 3-4 months. If, for                                  analyzes and well-being marked improvement,                                  then monitor the patient continues, but                                  Diet is not removed. If the effect is not obtained,                                  then tighten the diet. If even after 3 months                                  effect is not observed, then connect the medication                                  dasgs.                                  should be noted that treatment                                   atherosclerosis - a process long, complex and directly                                  say, an expensive. Medicines have to be applied                                  very long, in many cases - for life.                                  Therefore, to противоатеросклеротическим Dasgs                                  the ratio should be very careful and cautious.                                  There are several classes of dasgs,                                  used in atherosclerosis. Let's start with the most                                  widely used in recent dasg                                  - Statins.                                  So, statins . This is a relatively new,                                  the most active group of cholesterol-lowering                                  funds are derivatives of a new class of antibiotics.                                  Their impact occurs in the liver. Cholesterol                                  As we remember, not only comes with food,                                  but also formed in the body (its formation                                  occurs only in the liver). Statins block                                  formation of cholesterol in the liver, intercepting                                  this synthesis on one of the intermediate stages.                                  The cholesterol content in blood and liver                                  cells decreases. But liver cells is required                                  cholesterol, and they start hard to capture                                  it from flowing blood. Thus, in the blood                                  decreases cholesterol and that came with the food.                                  With statins include the following dasgs.                                  Here we must make onemoredigression. Case                                  that all dasgs have the name acting                                  substance , ie proper preparation, rendering                                  immediate impact. But beyond that,                                  Many dasgs have and trade names,                                   ie those names by which they are issued                                  those or other firms. For example, the familiar                                  Aspirin - a ton orgovoe name , and the current                                  beginning it is acetylsalicylic acid.                                  Brand names are usually written on the packaging                                  big, beautiful letters, but slightly lower (and                                  smaller letters) must be specified                                  active ingredient. For example, you can see in                                  package name Trombo-ACC and did not know that                                  it is. You lower your eyes to the next line                                  and read - acetylsalicylic acid and you                                  everything becomes clear. Exceptions may be                                  only for the composite and complex products,                                  but in this case a complete list of all components                                  (But not their trade names) must be listed                                  in the accompanying paper. When I tell                                  on dasgs, I'll call the first valid                                  beginning, and then in brackets - its main trading                                  name. Why? The fact that the store                                  and know all the brand names (like all firms,                                  producing pharmaceutical products) is impossible. (She has a                                  as acetylsalicylic acid, such as                                  at least three dozen trade names). Moreover,                                  in different countries, they are certainly different.                                  But knowing the active principle, you can always                                  find your desired product. And, if the pharmacy                                  you offer any substitute, you are immediately                                  understand if this is really what you're looking for.                                  You can just ask me: Does the                                  the same dasg, issued by different firms                                  under different names (if we take into account                                  that we are comparing the same dosage)? Alas!                                  very often they are different, that would not talk                                  pharmacists. Much depends on the filler, which                                  used in the tablet or tablets, by                                  purity, from the technology of manufacturing.                                  In Soviet times, once there was a sad and anecdotal                                  the case when in pursuit of over-fulfillment of the plan                                  on one of the companies on line, producing,                                  In my opinion, the analog eleniuma, increased speed     ⇒⇒⇒

Spring weather, therefore, changeable and unpredictable. Happy then heat up  plus twenty, and the evening is a minus two on the thermometer. Then rain, then snow, then  hell. Greenhouse effect, gentlemen. To such vagaries of weather and swings  atmospheric pressure, elderly people respond ... ro ⇒⇒⇒