Тhe concept, risk factors, mechanisms, clinical and epidemiological, and angiographic features of perioperative ischemic injury and myocardial infarction were considered. Perioperative myocardial infarction is one of the most common complications (up to 3.6%) in non-cardiac surgical interventions and is characterized by high in-hospital mortality, reaching 25%. Most patients with this pathology (up to 65%) do not have typical symptoms of myocardial ischemia due to anesthesia and sedation. Pathogenetic mechanisms of perioperative myocardial infarction development continues to be actively studied. A critical increase in myocardial oxygen demand is indicated as the leading cause in some studies. Angiography reveals rupture of the coronary plaque and atherothrombosis in more than half of patients, according to other data. These contradictions point to the need for further epidemiological studies using coronary angiography with a focus on risk factors and triggers of this complication. In addition, the concept of perioperative myocardial injury in recent years has been formulated in the scientific literature. This is understood as ischemic damage that occurs in the first 30 days after surgery. Recent studies have shown that it can occur in 16% of surgical patients and is associated with a 6-fold increase in mortality within 1 month after surgery and a 2.5-fold increase within a year. It is important that perioperative myocardial injury does not include cases of non-ischemic etiology myocardial injury, for example, due to pulmonary embolism, sepsis, or electrical cardioversion. Thus, the assessment and understanding of risk factors for the development of perioperative myocardial ischemia is of great practical importance in optimizing the patient selection and preparation for surgical treatment.
The clinical case of acute myocardial infarction and pulmonary embolism in a young soldier with the first occurred protracted attack of angina. The survey found the link between these conditions and gene mutation of type 1 plasminogen activator inhibitor that plays a key role in fibrinolysis by inhibiting the formation of plasmin and leading to slowdown in fibrinolysis processes and a longer-term persistence of blood clot. It is proven that homozygous 4G/4G mutation found in the patient results in the development of arterial and venous thrombosis at a young age and is associated with a tendency to relapse. It clearly shows that hereditary thrombophilia is characterized by the absence of obvious provocative factor and single universal diagnostic algorithm; the diagnosis is based on the comprehensive evaluation of laboratory data.
A comparative analysis of clinical and epidemiological data and results of treatment of 7 patients suffering from myocardial infarction without obstructive coronary artery disease (main group) and 54 patients with their lesions (control group) aged 45,69,3 and 62,714,2 years, respectively. Both groups were dominated by men (85,7% and 72,2%, respectively). In the main group, dyslipidemia and hypertension were less common (14,3 and 28,6%, respectively) than in the control group (61,1 and 72,2%, respectively). At the same time, the former had a more burdened history of early cardiovascular events in close relatives in 28,6% of cases, and the latter-only in 5,6% of cases. Surgical tactics and features of double antiplatelet therapy in myocardial infarction without obstructive coronary artery disease did not differ from the standard approach. In both groups, active surgical tactics prevailed, consisting in performing percutaneous coronary intervention and installing a coronary stent in the infarct-related artery (85,7 and 83,3%, respectively). The choice of dual antiplatelet therapy in the main group did not differ from the control group and was characterized by a significantly higher frequency of clopidogrel administration (71,4 and 72,2%, respectively). When comparing the left ventricular ejection fraction before and after percutaneous coronary intervention, it turned out that in patients of the main group, in contrast to the control group, the value of the left ventricular ejection fraction did not change significantly (52,56,4 and 51,39,5, respectively). The etiology and pathogenesis of myocardial damage in patients suffering from myocardial infarction without obstructive coronary artery disease is characterized by significant heterogeneity, which requires additional examinations and differential diagnostics to identify the underlying causes of this condition.
At the present stage of globalization development, the priority in the world economic system remains for the industrialized countries over the so-called agricultural countries. This state of Affairs was justified in the theory of political economy, which became widespread during the XVIII-XX centuries on the basis of comparative historical and comparative legal analysis of the works of the famous philosopher of law, economist, a prominent representative of the idealistic direction of the Russian neoliberal political and legal doctrine of the turn of XIX-XX centuries. Sergey Bulgakov, the author substantiates the need to address his agrarian theory of the world economy. S. N. Bulgakov opposes his own philosophy of economic management, based on the idea of the finiteness of the industrial stage of human civilization and the return to the nature-saving stage. According to him, the industrial stage leads to a decrease in the fertility of the earth, which, in turn, «triggers» the depletion of natural resources of the world. The philosophy of management («sofiology economy») is, on the one hand, in its materiality, as a result of the development of the world, and on the other - as God’s grace, the remuneration of man for his earthly Affairs. In contrast to the Marxist theory of labor value, the philosopher of law proposed a physiocratic theory of rent, suggesting pricing policy on the part of the agricultural sector of the economy. Unlike the theory of political economy, where industrial countries occupy an excellent position in front of agricultural countries, agricultural theory S. N. Bulgakov recognizes the priority of those countries in which there is no effective regulation of the agricultural sector. The author concludes that it is necessary to revise the role of countries engaged in agricultural production, and especially Russia in the world economy, based on the philosophical and legal heritage of S. N. Bulgakov.
Objective. The aim of the study was to compare the morphometric parameters of echocardiography in a normally occurring pregnancy. Comparison of the obtained data with the data of heart measurement in children perinatally perished, as well as the analysis of the mass indexes of the fetus and placenta in healthy fetuses and fetuses perinatally lost. Materials and methods. We analyzed 94 protocols for the investigation of post-mortem and the protocols for autopsy of fetuses and newborn infants perinatal in various maternity hospitals in St. Petersburg and the Leningrad Region (group 1). The control group 2 consisted of 12 patients who were registered for pregnancy, were examined according to the usual pattern, later they had urgent deliveries to healthy newborns, the histological structure of the placenta was represented by reactive and compensatory-adaptive changes characteristic of the placenta of the normal structure. Patients of control group 2 underwent evaluation of echocardiograms obtained during the third screening test during pregnancy, performed at the time of 32-34 weeks. Control group 3 included 335 observations of full term pregnancy, which resulted in the birth of a healthy fetus. In this group, an analysis was made of the mass indexes of the fetus, placenta, and the integral index of the placental-fetal ratio. Results of the study. Massometric parameters of the fetus, placenta and integral index of the placental-fetal ratio in the patients of the main and control groups were analyzed. Typical changes in the weight of the placenta and placental-fetal ratio in patients with perinatal fetal death were determined. Opportunities were identified for risk groups for perinatal fetal death according to the analysis of the sonocardiogram. Conclusion. 8 conclusions are presented that represent the possibility of predicting perinatal losses depending on the size of the placenta, placental-fetal ratio, the isolation of risk groups for perinatal fetal death according to the data of sonocardiography
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