Blužas, Juozas

Akademikas Z. Januškevičius ne kartą kartojo, jog "šių dienų mokslas vis labiau ir labiau reikalauja atsisakyti masinių atakų taktikos, puolimo visu frontu, ir sutelkti jėgas atskiruose mokslo baruose, organizuoti gerai apginkluotus sudėtinga technika ir savo veiksmus darniai derinančius kvalifikuotų specialistų kolektyvus, sprendžiančius specializuotus uždavinius." Ši akad. Z. Januškevičiaus mintis buvo bene pirmasis impulsas koncentruoti Kauno kardiologų jėgas išeminės širdies ligos problemoms spręsti. Širdies ir kraujagyslių sistemos susirgimų problema Z. Januškevičiui nebuvo svetima. Dar būdamas fronte jis susidomėjo nervinės įtampos (streso) įtaka arterinio kraujo spaudimo padidėjimui ir svyravimams. Sukauptą medžiagą šiuo klausimu apibendrino kandidatinėje disertacijoje, kurią apgynė 1947 metais. 1951-1953 metais, gyvendamas Maskvoje ir vadovaujamas prof. Miasnikovo, ruošdamas daktarinę disertaciją, Z. Januškevičius nagrinėjo aukštosios nervinės veiklos ypatumus sergantiems koronariniu nepakankamumu. Daug įtakos Z. Januškevičiui turėjo ilgai nuoširdūs pokalbiai su prof. Votčalu, kurį nepaprastai gerbė ir mėgo visą gyvenimą. Dar studijų metais, apie 1930-1935 metus, Z. Januškevičiui labai imponavo prof. Buinevičiaus vedamos pratybos, ligonių aptarimai, kurių metu sergantys miokardo infarktu ligoniai buvo retai aptariami. Tai nėra dažnas susirgimas, tuomet buvo sakoma - tai praktiškai paskutinė krūtinės anginos fazė ir išgydyti tokį ligonį sunku, jis dažniausiai miršta. Praslinkus vos 20 metų išeminė širdies liga užgriuvo civilizuotus kraštus. Iš dalies tai, kaip sakydavo Z. Januškevičius, nebuvo staigi griūtis. Išeminės širdies ligos nemokėta diagnozuoti - širdies paralyžius, širdies plyšimas, širdies astma - štai į kokias diagnozes jis atkreipdavo dėmesį, po visais tais pavadinimais galėjo slypėti išeminė širdies liga. [...]

Background — The majority of deaths due to acute coronary heart disease (CHD) occur outside hospital, unexpectedly, within the first few hours following the onset of the terminal event. Data on the incidence and nature of acute pathological findings in the affected hearts as seen in routine autopsies are somewhat controversial. Detailed pathological examination of coronary arteries and myocardium of such decedents was performed to clarify the situation. Methods and results — Full autopsy and detailed macroscopic and microscopic examination of the coronary arteries and myocardium were performed in 170 men, all registered in the Kaunas Acute Myocardial Infarct Register, who died outside hospital of CHD within 6 hours from the onset of symptoms. Out-of-hospital coronary death was in all cases related to acute ischaemic myocardial lesions, either myocardial infarction (MI) in 92.9% of cases or patchy micronecrosis in 7.1%. In the former group, the following stages of acute infarction were found: early MI (hyperacute phase) in 48.8% of cases, definite MI (displaying grossly identifiable coagulative necrosis) in 21.8% and progressing MI (presence of signs of early MI adjacent to a healing infarction) in 22.3%. Signs of new thrombotic coronary events were found in relation to these acute ischaemic myocardial lesions in 88.8% of cases, as occlusive thrombus in 41.2%, non-occlusive,mural thrombus in 37.0% and microthrombi/microemboli in intramyocardial vessels in 10.6%. Conclusions — Out-of-hospital coronary death most commanly was related to the early or definite stages of myocardial infarction. Accurate identification of these acute ischaemic lesions was based on detailed microscopic examination of the entire ventricular myocardium, with consideration being paid to signs of cardiomyocyte involvement and early inflammatory reaction associated with it [...].

A computerized approach of nonlinear dynamics analysis of electrocardiogram (ECG) signals was applied for the detection of coronary artery disease (CAD). The proposed nonlinear dynamics descriptors were derived from 12-lead rest ECG data, and evaluated by originally developed computer software. Fluctuations of potentials of ECG leads that occur during the period of 20 ms with a magnitude of 5–20 μV were significantly less beat-to-beat predictable in ischemic versus non-ischemic patients. The well-known nonlinear dynamics descriptors, recurrences percentage, mutual information, fractal dimension, and a new descriptor, next embedding dimension error, were good quantitative descriptors of fluctuations. They were significantly different (

Didelė dalis širdies ligų diagnostinių kriterijų gaunama registruojant ir analizuojant kardiosignalus, kurie atspindi tiek elektrinės širdies veiklos sutrikimus (EKG), tiek hemodinaminės bei mechaninės veiklos pokyčius, t. y. impedanskardiogramą (IKG) ir seismokardiogramą (SKG). Efektyvus širdies ligų diagnostikos problemų sprendimo būdas – kurti naujas kardiosignalų analizės technologijas. Jau kelis dešimtmečius Furjė transformacija taikoma EKG dažnių analizei, o IKG ir SKG dažnio charakteristikoms vertinti šis metodas nebuvo taikomas. Darbo tikslas buvo pritaikyti Furjė analizę trims sinchroniškai užregistruotiems kardiosignalams įvertinti bei palyginti, nes jie atspindi elektrinės širdies, hemodinaminės bei mechaninės širdies veiklos pokyčius geriau nei vienas EKG signalas. Kitas darbo tikslas buvo pritaikyti Furjė analizę trijų sinchroniškai užregistruotų signalų – EKG, IKG ir SKG dažnio charakteristikoms ir koherencijai įvertinti bei palyginti.

The use of automated informational data processing system (created in 1988-1989) allowed to accumulate unique information on the health status of 12,241 men aged over 15 years. Data base includes information on risk factors (arterial hypertension, excess weight, smoking), occupation and character of work, requirements in specialized care, volume of investigations throughout the period of 11 years (1988-1998). Of 12,241 men 1,132 (9.2%) died and all causes of death were documented. Application of modified Weibul and logistic regression models with inclusion of such informative indicators as ischemic heart disease, tumors, diabetes mellitus, arterial hypertension, excess weight, smoking, character of work, the number of deaths in male population for 10 years could be predicted with accuracy >91.0%. The use of these models gives an opportunity to detect groups of men with elevated risk (with ischemic heart disease, tumors, diabetes mellitus, arterial hypertension, excessive weight, smoking, top executives by character of work) for application of preventive and appropriate health measures, since the majority of informative predictors of death are correctable.

Aim of investigation was to study rate of remote cardiovascular complications after aorto-coronary grafting (ACG) in patients with ischemic cardiomyopathy and revelation of informative pre- and early postoperative markers of left ventricular (LV) function for determination of prognosis of cardiovascular complications and functional state of patients in remote postoperative period. Doppler echocardiographical parameters of left ventricular function were assessed in pre- and early postoperative period in 107 patients in whom cardiovascular events did not recur in late postoperative period (during 1 year) and in 63 patients who had recurrent cardiovascular events. Influence of a sign (x) on probability p(x) of cardiovascular events in postoperative period was estimated on the basis of logistic model. Rate of cardiovascular complications during 1 year after ACG in patients with ischemic cardiomyopathy was 40%. Most significant prognostic markers of cardiovascular complications in remote postoperative period were LV ejection fraction and deceleration time of early filling before surgery and in early postoperative period, as well as LV end systolic diameter in early postoperative period (p<0.05).