Based on the analysis of 39 observed cases, the authors consider various aspects of the use of roentgenovascular dilatation by an axillary access: problems of methods, indications and contraindications; they also assess the advantages and shortcomings of the access.

The radio-angiographic features of coronary blood flow were studied in 119 patients in the first 24 hours of a macrofocal myocardial infarction. In 100 (84%) patients with recognized occlusion of the coronary artery responsible for the infarction the semeiotics of the occluding coronary thrombosis is described, and the characteristics of the residual stenoses after intracoronary thrombolysis were studied. In more than 60% of cases the radiographic features of these stenoses were found to be similar to those of primarily revealed stenoses responsible for infarction of the coronary arteries in degree, form, and the presence of mural thrombus. The mechanism of the formation of these stenoses was of a common character--lysis of the occluding thrombus, which was medicinal in the first case and spontaneous in the second. Medicinal thrombolysis is an analogue of the natural physiological mechanism--spontaneous coronary thrombolysis. It was established that the process of medicinal lysis of the coronary thrombus, a mural thrombus among others, is fully completed by the end of the second day of myocardial infarction. The obtained information makes it possible to formulate some principles of radiologically-guided intravascular treatment of patients with myocardial infarction.

Basing on the analysis of 39 observed cases, the authors consider various aspects of the use of roentgenovascular dilatation by an axillary access : problems of methods, indications and contraindications; they also assess the advantages and shortcomings of the access.

Hemorrhagic myocardial infarction (HMI) has certain angiographic features that make it possible to diagnose it during the patient's life. HMI angiographic criteria are hypervascularization of an infarction zone in the late arterial phase, an intense contrast of an infarction zone in the parenchymal phase, extravasation of a contrast medium in an infarction zone in the venous phase of coronarography lasting for a long time, and slow discharge of a contrast medium from the distal vascular channel of an infarction zone. HMI characteristic features require thorough phase-by-phase angiographic investigation of the coronary arteries in all MI patients, especially in young ones and those after intracoronary thrombolytic therapy. The detected morphological spasm of microcirculatory vessels and veins disturbing the blood outflow from an infarction zone, noticeable hemorrhages in its interstice prove to be the morphological substantiation of HMI angiographic signs.

In line with clinical benefits observed in the diagnosis and treatment of arteriopathies, invasive methods currently introduced in a wide practice entail some negative sequelae presenting with specific complications with occasional lethal outcomes. Because the complications are so closely related to pathogenesis and outcomes of the disease, they should be thoroughly analyzed in view of their role and place in the conceptions of thanatogenesis and pathological diagnosis in which they can be introduced as the main, concurrent or competitive disease, registered as complications depending on the role in the thanatogenesis and initial status of the patient assessed both by the clinician and the pathologist before the invasive procedure.

The authors have used selective angiography of the upper and lower mesenterial arteries in patients with scary constriction of the esophagus in order to obtain data of blood supply of the colon before operation of esophagus plasty and to give preliminary grounds for surgical tactics. The method was used in 37 patients operated upon. In ten of them angiography of the upper mesenterial arteries has shown contrasted veins. Coincidence of the pathway of arteries and veins was noted in 1 patient. Angiography of the lower mesenterial artery has shown coincidence of the pathway of arteries and veins in 16 cases, i.e. in all the cases where the venous phase was fulfilled.

The results of coronary angiography in 108 patients within the first 24 hours of myocardial infarction were compared to autopsy coronary arterial findings in 78 cases of myocardial infarction death within similar periods of time. The rate of occlusion of the coronary artery, responsible for infarction, dropped considerably within 12-24 hours of its onset, as compared to the data obtained within the first 6 hours: from 90.3% to 57.1% as evidenced by coronarography, or from 87.8% to 68.4% as evidenced by postmortem findings. Coronarography conducted within the first day of myocardial infarction demonstrated markedly activated fibrinolysis that coincided with the drop in the incidence of coronary-arterial thrombosis. Fibrinolysis activation is a prerequisite for spontaneous coronary thrombolysis.

The work is based on an analysis of data obtained in angiographic examinations of 80 patients with blunt traumas of the abdomen.

The effect of standardized mental stress on the hemostatic system was studied in 160 patients with coronary heart disease. The diagnosis of coronary atherosclerosis was documented by selective coronary angiographic findings. Emotional tension was modelled using the method of counting with interswitching in conditions of time deficit, irritating light and sound signals, as well as critical remarks about the work performed. According to the protective-adaptive activation of the anti-clotting system, the patients were divided into two groups: 1 with activation of heparin activity of the blood and fibrinolysis, 2 with depressed fibrinolysis and lowered blood heparin. Prior to the onset of the study the patients of both groups exhibited hypercoagulation as compared with the control group. The maximum degree of hypercoagulation was observed in the second group patients. Hypercoagulative changes both at rest and under stress were shown to depend on the degree of coronary artery damage.

Simultaneous measurements by the Fick direct method and the Kubicek rheographic method of cardiac output of 20 men with ischemic heart disease have shown that both methods are well correlated (r = 0.76, k = 0.92, n = 41). The reproducibility of the Kubicek data was slightly better than the Fick data (on the average +/- 6% instead of +/- 9-10%). An attempt of increasing the correlation of the Kubicek data with the Fick data by correcting the specific resistance with respect to the hematocrit data and the chest perimeter failed. In order to provide the necessary accuracy of the Kubicek method, it is required that the procedure be stringent and the five variables in the formula for calculating cardiac output be precisely measured. The cardiac output values determined simultaneously by the Kubicek method and by x-ray contrast ventriculography showed a better correlation (r = 0.88, k = 0.97, n = 15).

Selective coronary angiography was performed and variations of blood serum lipid levels were studied over time in 45 myocardial infarction survivors under 40 years of age. The results showed that the development of myocardial infarction in young individuals is underlied by coronary atherosclerosis. Hyperlipidemia was elicited in a larger proportion of cases as compared to changes on coronary angiograms, since the latter record only marked alterations whereas the initial stage of the active atherosclerotic process is manifested in changed lipid and lipoprotein concentrations in the blood serum in the absence of any changes on coronary angiograms. Functional impairments of the coronary circulation were implicated in the genesis of myocardial infarction only in 17% of the patients.

Correlation of electrocardiographic and coronarographic findings in patients with severe chronic coronary heart disease and massive coronary arterial lesions has demonstrated a tendency to increasing proportion of clinically normal electrocardiograms as more arteries are drawn into the pathologic process. Relationships between ECG voltage and different variants of coronary arterial damage are reviewed: the involvement of the right and part (at least one branch) of the left coronary arteries corresponds to low-voltage ECG. The association between left-ventricular aneurysm and the number of affected coronary arteries is examined.

Results of a Moscow--Berlin collaborative study of urgent coronarography in acute myocardial infarction, using intracoronary treatments (fibrinolytic agents and mechanical thrombus destruction), are reported. Urgent coronarography was performed in 58 patients. Coronary flow could be recovered or improved in 27 patients, as evidenced by control coronarographic tests, particularly late follow-up ones. The procedure did not prevent myocardial infarction, but alleviated its course.