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The advantages of this method are a better geometrical integrity of the tricuspidvalve and a later reduction in the need for pacemaker implantation 8, 9, 10, Performing a tibioastragalar arthrodesis we achieve a stably painless anklebut for the cost of a definitive joint jam, well tolerated. The article discusses the currentguidelines for the indication of thoracic transplantation. Neoton prevent irreversible changes inreperfusion by maintaining tissue pH, blocking sarcoplasm acidification because Contributions to the biopathologic study of myocardiumby repeated intraoperative myocardial biopsyaccumulation from lactate and alanine, results in high consumption of glucoseand lactic acid, preventing injuries.

Fundeni, nr. Anatomoclinical experience Personal view Nicolae M. In cases of acquired heart disease,especially cardiac malformations and various valvular heart disease. Candeaperformed myocardial biopsies, both before installing extra-body circulation E. Casa focal point of previous injuries and at every sometimes 54minutes after clipping the aorta to the involutive influence of E.

Different morphological examinations were performed,especially using electonomicroscopy at Victor Babes Institute by the team led of dr.

Under the influence of situation of "shock-controlled" ultrastructural changes —type stunning occur in the first minutes predominantly in the mitochondria,sarcoplasmatic reticulum, followed progressively by hypoxic injury at the vascular andcellular membranes.

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Evolution of mentioned lesions at the level of organites determinesadvance of the transition from limited reversibility of lesion, those minutes, tothe alterations appearance with irreversible evolution, from 30 minutes, withdisorganization and lisis at sarcomers by lysosomal enzymes, edema peri andintrasarcoplasmatic, to apoptosis and necrosis. The beneficial aspect of treatment withphosphocreatin over. In cases of cardiac ischemia are given morphological aspects ofmyocardial hibernation as adaptive differentiate embryofetal, viable but withevolutionary potential in the absence of lesion of revascularization surgery.

The paperpleads for the benefits of scientific and practical application of these methods by cardiosurgeons as cum de a scrie un profil bun de dating uk investigation. Keywords: open heart interventions, intraoperative myocardial biopsy, biopathology1 Academy of Romanian Scientists, Bucharest, 54, Splaiul Independentei, Author forcorrespondence: Professor Vasile Candea, aosromania yahoo.

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Pe cazuri neds declasificat double dating partea 1 cardiopatii dobândite, îndeosebi valuvulopatii şi variate malformaţii cardiace,V. Cândea a efectuat biopsii miocardice, atât înaintea instalării circulaţieiextracorporeale C. Sub influenţa stării de "şoc controlat", modificăriultrastructurale de tipul siderării apar în primele minute predominând la nivelulmitocondriilor, reticulului sarcoplasmatic, urmate progresiv de leziuni hipoxiceinteresând sistemele de membrane vasculare şi celulare.

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Evoluţia leziunilor organitelormenţionate a activării leziunilor determină progresiv trecerea de la limitareversibilităţii lezionale, respectiv minute, la apariţia alterărilor cu evoluţieireversibilă, de la 30 min.

Esteredat aspectul benefic al terapiei cu fosfocreatină asupra structurilor cardiomiocitelor. În cazurile cu ischemii cardiace sunt redate aspecte morfologice ale hibernăriimiocardice ca diferenţieri embriofetale adaptative, viabile dar şi cu potenţial evolutivlezional în absenţa revascularizării neds declasificat double dating partea 1.

Lucrarea pledează pentru beneficiileştiinţifice si practice ale aplicarii de catre cardiochirurgi ale acestor metodologii deinvestigare intraoperatorii.

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Cuvinte-cheie: Intervenţii pe cord deschis, biopsii miocardice intraoperatorii,biopatologieIntroductionWide range of laboratory investigations of the myocardium subjected toopen heart surgery under extracorporeal circulation E. Description of morphologicalcardiac lesions were performed only on single intraoperative myocardial biopsyby various authors.

This is done on open-heart surgery, clipping off the aortic bulb in terms ofshock control 6 of stunning, named by various authors mentioned especially byBraunwald and Carp, defining contractile disturbances duration variable in ourcase by clipping the aorta and restore circulation after declipping persistingcontractile disorders.

During this period a number of series of metabolic injuriesoccur due to the changes at the level of organites, cytosol and extracellularmatrix. These biochemical changes are necessary to know, considering the factthat due to high degree of congestive heart failure CHF in many patients, theprolonged duration of the operation, in some cases, and cardioprotective effect Contributions to the biopathologic study of myocardiumby repeated intraoperative myocardial biopsyinfusions with various cardioplegic effect solutions in continuous improvement sostill performing poorly, reversible changes may develop into lesions withirreversible trends.

In the absence of such data in the literature, we considereduseful to our experience, first performed in Romania, modern morphobiochemistrystudy, myocardial biopsy performed at specified time interval. In the period were made in the Service of Cardiovascular Diseases, founded by V. Candea, at the Central Military Bună scrisoare intro pentru dating online, various heart disease by the teamled by V.

Candea, whose myocardial biopsies were examined separately by Dr. Prunescu only electonomicroscopical at the Institute of Biology. Between a total of cases operated for valvular mitral, aortic, mitral-aortic,tricuspidien sterile or effusionor to correct heart malformations DSIP, DSIV orboth, Fallot diseasesome associated with drainage anomalous vein,transposition of great vessels.

Laky at V. Babes Institute performed numeroushistopathological, histochemical, biochemical and electronomicroscopicalstudies In this study we included cases of pre, intra and neds declasificat double dating partea 1 myocardialprotection with phosphocreatin The results obtained conferred us themotivation to present the methodology of the study, adding to the usefulness ofexpanding knowledge on the evolution of all morphological and biochemicalsubstrates in the context of these surgical interventions and non-identifyelectrocardiographic and sometimes disagreeing with the clinical assessment ofa class of ICC in order to adapt appropriate therapeutic means.

Stress that in anysuch case had operated physiological disturbances during and after therepeated biopsies in the context of most of the cardio surgeons adopt thismethodology to study, many expressed their fear of complications orunmotivated considering morphological study in the context of range oflaboratory investigations. Material and MethodsOf neds declasificat double dating partea 1 large number of operated heart disease, we selected for this study, cases in which intraoperative biopsies were performed at the same intervalsand morphological investigations remained unchanged.

For interpretation of theresults were taken into account by the ICC class NYHAmost falling within thethird class, the existence or not of HTP, mostly moderate, other associateddiseases especially diabetes, atherosclerosis, systemic hypertension as the age predominantly from childhood in malformations and in valvular diseasesometimes exceeding 70 years with male predominant The lot of study wasformed by: Acquired heart disease and degenerative especially Valvularpostrheumatic disease and, mitral, aortic, mitroaoric, tricuspidan lesssterile and septic rarely subject valvulotomy and valvuloplastia.

Это было, когда Наи.

Atheromatous Ischemic Cardiomyopathy were performed biopsiesonly in atrial areas and diskinetic zone which bypass were performedby the collectives Goleanu, Patrut, Mocanu on 50 cases from theirrich collection of cases, studies in which D. Laky performedimmunohistochemical investigations. Surgical interventions was performed under conditions of moderatehypothermia in open heart under E. Popataking myocardial biopsies beforeclipping the aorta from the right auricle reflecting the morphological status of theheart and aorta after clipping and installation E.

Results and DiscussionsThe originally lesion pattern, built gradually in years, we studied on biopsiesbefore clipping the aorta, set up criterion for assessing aortic lesions after clipping. Histological examinations revealed little information: vacuolation, deletingsarcoplasmatical structures, acidification of the cardiomiocytes cytoplasm eosinophilia, glycogen changes, interstitial fibrosis, hypertrophy andhypercromation nuclear, thickening of arteriolar walls.

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We noticedhistoenzimologic decreases to mitochondrial marker enzymes citocromoxidase,SDHleads to the biochemical and tissue fragments. Electonomicroscopical exams revealed a range of progressive lesions whoseemphasis we present below. Literature data show normal structure organites and other componentscardiomiocytes, injuries issues and their interpretation.

Although, they revealedfrom the first minute in detail, the unfisiological effects of E. Contributions to the biopathologic study of myocardiumby repeated intraoperative myocardial biopsyDeterioration of neds declasificat double dating partea 1 through the created shock by clipping the aorta,generating an infusion leading to inadequate tissue ischemia progresses to theextent that the shock and consecutive metabolic disorders.

Thus in terms ofmetabolic cardiomiocytes from cell that consumes lactate for energy becomes aproducing lactic cell. After clipping the aorta and installation of E. Figure 1 - Injury sarcolemalwith vacuolisation, edemaand intraperisarcoplasmatic,mitochondrial damage theZ lines X13 minutesafter clipping the aortaSarcolema presents early hypoxic alterations, ultrastructure illustrated vesiclesof pinocitoza, and later by vacuolization subsarcolemal dehiscence, disturbancesof diffusion hypoxia.

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Starting from the first minutes 2, 5, 6, 10, mitochondria Figure2 First organites affected appear Their visual appearance varies, passing through a series of steps from thereversible to the irreversible, fragmentation and deletions of myofilamente, loss ofgranules to their disappearance, obtaining detailed images on mitochondrialsuspensions Figure 3.

Sarcoplasmatic reticulum presents early postischemic alterations, which arecharacterized by expansion in the early stages that progress to the fragmentationof membranes and the appearance of plexiform areas in sarcoplasma Figure 5. Lysosomes are organites that play an important role in the economy and the lifecycle of cells especially in advanced stages.

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Lysosomal alterations proliferated from perinuclear area Figure 6 withvarious shapes and arrangements, issued by the disturbance of permeability ofthe membrane, protease, lipase, phospholipase, sulfatase, glicoronidaze, acidphosphatase, catepsine. They may alter the integrity of surrounding structuresand function of cell metabolic changes incurred during the duration of clippingalong with the advancement of the aorta.

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Figure 5 - Cardiomiocit portion expansionof various sarcoplasmic reticulum, nucleuswith cromatinian marginalisation, 20minutes after aortic clipping X. Figure 6 - Perinuclear lysosomes withextensive trend within sarcoplasmei withvarious injuries X25 minutes afterclipping the aorta. Contributions to the biopathologic study of myocardiumby repeated intraoperative myocardial biopsyAll these stages of evolution from hyperplasia appear second lizozomsforming fagolisosoms Figure 7.

Finally, determine the enzymes released by thedisintegration of structures leading to cell death concomitantly with theappearance of myelin bodies Figure 8. Figure 7 - Fagolizozomi crowdedperinuclear X in 30 minutesFigure 8 - Myelin body in the vecinityof mitochondria with rupture of growthand tendency to vacuolation X Atrial natriuretic granules 16become visible in growing numbers inconditions of hypoxia The repeated biopsies, we have met and in theventricles The aspect is spherical with electron dens content of 2.

Throughits activity give endocrine feature to the heart Fluid balance influences Na-H2O issued consecutive ion pump damage 17, Resting potential decreases hence the decrease ofexcitability cellular. The number and their extension increases with worseningheart failure.

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Figure 9 - Proliferatednatriuretic granulesin the vicinity of the nucleusinside sarcoplasm Vasile CÂNDEA, Dezideriu LAKYMyofilaments and discs gradually suffers interlacing dissociation anddisintegration mainly due to edema intrasarcoplasmatic, tapes and discs isfragment insertion, the intherior sarcomer structure, nuclear changes occur inadvanced stages and, ultrastructural, they are showed by marginalizationheterocromatin and by the appearance of dense chromatin.

Extracellular matrix causing suffering progressive morphobiochemicalalterations, finally lead to myocardosclerosis and increased heart failure 31 ,capillaries present changes of basement membrane, with vesicles of pinocitosisincreasingly numerous and endothelial cells appear turgid and festoned.

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Ultrastructural aspects vary from one microscopic field to another evenwithin a sarcomer, that the labeling stage lesion requiring multiple sections. Theaccuracy of these changes electronomicroscopic is certified by esperimentsresults which simulates various forms of myocardial ischemia observed by teamled by Dr.

Laky for a decade, and described in his monograph Bothvalvulopaties 19, 20 and malformations 21 painting ultrastructural lesion wasnonspecific and intercept compared with the previous state of the patientespecially ICC class NYHAa pre-existing hypoxia, alterations observed in theprevious biopsy experience and caution required by the Examiner. In this way,were determined adaptive changes within sideration process, reversible earlylesions from those, that are at the limit of reversibility after minutesmorphofunctionaly viable and the lesions that evolved after minutes toirreversible status of apoptosis and necrosis.

Following the dynamic changes inmyocardial cardioplegic infusion solutions, we found in the majority of cases, theirefficiency in miocardoprotection 14lesions, with few exceptions, not exceedingreversibility limits of lesions. Alexandru Popa has devoted his doctoral thesis to efficiency continuousinfusion of cold cardioplegic hyperkalaemic solutions Inauspicious results,demonstrated electronomicroscopicaly, were noticed in cases of ICC class IV NYHA in endocarditis with septic embolism 22, 23 and in some patients, inwhom the time of surgical operators have exceeded 45 minutes, such as, indouble or triple valves prosthetic process or complex malformations.

In these patients we found hyperplasias and lysosomal activation, frequentphagolisosoms, increased tendency to swelling of mitochondries, the interstitialand intrasarcoplasmatic edema. Capillaries present vesicles of pinocitosis common in basement membranes,and in the final stages of lysis, appear myelinic bodies, mitochondrial swelling andprogressive sarcoplasmatic lisis with nuclear picnosis.

Biochemical exams wereconsistent, signaling decreases in mitochondrial enzymes and increases in thethose lysosomal. From histoenzimological point of wiew, values of acidphosphatase, catepsin B lysosomal enzymesas well as LDL, were consistent withthe severity of lesion images. A particular aspect we studied was that ofmiocardoprotection pre, intra and postoperative with fosfocreatina Neoton For accurate results were studied two groups of patients operated for Contributions to the biopathologic study of myocardiumby repeated intraoperative myocardial biopsyvalvulopaties respectively untreated and treated.

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In these groups, biopsies andinvestigation techniques were the same as in previous cases. In cases wheremyocardial biopsies from patients treated with Neoton them, the picture appearswith lesions morphologically reversible Figure 10compared with untreatedgroup presents severe lesions hyperplasias of fagolizozomi, sarcomeres withadvanced disintegration with mitochondrial damage and edema Figure Figure 10 - Miocardium after preand intraoperative treatment withphfosphocreatin- injuries lightweight,reversible, with moderate dilation ofthe reticulum sarcoplasmatic, lightmitochondrial changes, disruptionsof the Z lines X20 minutesafter clipping the aortaFigure 11 - Myocardium in a patient withuntreated fosfocreatin Neoton presents: fagolizozom severe alterationof mitochondries and deletingsarcomeres structures x20minutes after declampationSo, the apparent tendency of glycogen recovery and sarcoplasmacidification and myocitic edema are much lower.

Lysosomal enzyme activity is reduced, so the aorticclipping the changes appear smaller. Electronomicroscopic examination Figure12 also observed a betterpreservation of cellular organits, storage non-fragmented miofilamentes [12a], Zbands and disseminated intrasarcoplasmatic glycogen granules [12b], andbetween miofilamentes, mitochondries with membranes and crests preserved.

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Vacuolo-lysosomal system is reduced by untreated group, suggesting a slowphenomenon cytolysis [12c]. Bazal membran of endothelial cells present an increased stability, causingperivascular edema reduction, inter and intramyocitar.

Во всяком случае они стоят во главе сложной иерархии. И существо, наметившее для нас с тобой этот маршрут, бесспорно, полагало, что новые познания облегчат нам дальнейшие контакты. - Но если это действительно октопауки, что помешало им похитить нас, как Эпонину и Элли. - Не знаю, - ответил Ричард.

Restoration of spontaneous heart rate. Reducing energy needs due defibrilation. Inischemia, the myocardial energy reserves ATP, CPare fast consumers andglicolysis stops at gliceraldehidphosphat, step leading to loss of oxidation phaseof cellular NADH- causing acidification of cytoplasm.

Neoton, is a source necessary to prevent oxidative phosphorylation stop andavoid metabolizing phospholipids in membranes, resulting sarcomeresstabilization and membranes capillary.