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Разработка аутомышечной системы вспомогательного кровообращения для хирургической коррекции сердечной недостаточности (Экспериментальное исследование). Москва, 1989: 226 стр
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In striving for an energy supply of artificial organs independent from external energy sources, the chronic stimulated, cross-striated muscle is of special interest as an internal generator. Especially in the field of artificial heart replacement (1, 2) it is necessary to have an implantable, external energy source at one’s disposal or to make an internal energy source accessible. The whole system “Artificial lieart” consists of the energy source, the transfer of energy, the drive, the control with probes, and the blood pump. Whereas the blood pump is nearly always implanted intracorporeally, there exist only a few solutions to the problem of how to implant the transfer of energy and the drive (3). The additional implantation of both, i. e. the source of energy and the control, was only achieved in some cases. The main problem concerns the source of energy, which up to now was only achieved by a disintegration of radioactive material (4). Because of the high costs and the growing hesitations about the use of atomic power, the search for internal energy production is placed in the foreground. Man is able to produce a mechanical muscle power of about 300 Watts for a short time and of about 50 Watts for a longer period. Compared with the power output of the heart of about 3 Watts, there can be no doubt that this energy can be produced by muscular activity. The muscle should work automatically by means of chronic stimulation using an electric stimulation-generator similar to a pace-maker.
Since Jacobey [8] presented the first experimental data suggesting the efficacy of counterpulsation as a treatment for acute coronary occlusions, the concept of myocardial revascularization and the salvage of ischemic regions of the myocardium associated with coronary occlusions has gained wide acceptance. More than 70,000 coronary bypass operations are now performed annually to relieve the symptoms of angina. And high priority has been assigned to clinical studies to assess the effectiveness of aggressive early treatment of myocardial infarctions to reduce the size of the infarct by improving the “supply/demand” metabolic status of the ischemic region of the myocardium. This trend towards early therapy and timely intervention in the treatment of angina and myocardial infarctions has placed the emphasis on the development of effective treatment modalities which are practical and safe enough for elective application to patients who are not at immediate risk. Most assisted circulation research has been directed to the development of systems that can maintain adequate perfusion of the organism in the face of profound shock. The possibility that mechanical circulatory assist can serve a widespread therapeutic need is exciting.
Es wird über eine Serie von 12 konsekutiven Rekonstruktionen von Brustwanddefekten 1986 berichtet: es wurden 9 musculo-cutane Lappenplastiken benutzt, davon 7 Latissimus dorsi (1 mikrovasculärer freier Lappen) und 2 Rectus abdominis-Lappen. Trotz der gefundenen Komplikationen (postoperative Blutung, paradoxe Beweglichkeit der Brustwand) erscheint uns der musculo-cutane Lappen für die Rekonstruktion grosser Brustwanddefekte die Therapieform der Wahl zu sein, insbesondere im infizierten Wundgebiet und nach vorausgegangener Bestrahlungstherapie.
The use of the reverse latissimus dorsi myocutaneous flap for the closure of skin defects of the back is reviewed and two case reports are described.
The neuromuscular system can adapt to a variety of different kinds of chronic workloads. The specificity of these adaptations is reflected in the specific components of the neuromuscular system that are overloaded. An examination of changes that occur during normal development can serve as a basis for efforts to understand the mechanisms which are responsible for the maintenance of a given histochemical, biochemical and physiological profile of a motor unit. The normal process of muscle development can be retarded by spinal transection or immobilizing a neonatal muscle and some of the neonatal features can be reintroduced in adult animals by these same procedures. In general the speed related properties of fast skeletal muscle are not altered markedly by any type of physiological overload. There is some evidence that immobilization or intense endurance trained slow muscle is faster than the normal muscle. The metabolic properties related to maintenance of tension during prolonged work are readily adaptable to chronic low resistance-highly repetitive contractions. Factors that determine the specificity of the response to neuromuscular overload seem to be motor unit recruitment frequency, the tension produced within the musculature and the duration of the tensions.