[The clinical and hemostasiological features of chronic hepatitides of different genesis].

AIM: To comparatively characterize clinical, biochemical, and hemostasiological parameters in patients with chronic alcoholic hepatitis (CAH) and chronic mixed hepatitis (CMH), i.e. CAH + chronic hepatitis C. SUBJECTS AND METHODS: Sixty-three patients (mean age 39.05±4.95 years) with chronic hepatitides of different etiology, who underwent general clinical, biochemical, and hemostasiological studies, were examined. RESULTS: The frequency and duration of major clinical symptoms were maximally pronounced in the patients with CMH. Aspartate aminotransferase concentrations were significantly decreased only in the patients with CAH, remaining at higher levels in CMH. The activity of γ-glutamyl transpeptidase was twice higher in CAH. In the patients of both groups, the total concentration of nitrates and nitrites was recorded within the normal range and the activity of von Willebrand factor was significantly higher than normal. The aggregation of platelets and erythrocytes in the patients of all the groups was significantly lower than that in the healthy individuals, but differed at different disease stages. CONCLUSION: CMH was ascertained to have a more severe course. The hemostatic system did not significantly depend on the etiology of hepatitis, but was variable in different periods of various hepatitides.

[Implication of functional platelet activity in pathogenesis of Q-fever].

AIM: To ascertain the role of platelets in pathogenesis of clinical symptoms in patients with Q-fever. MATERIAL AND METHODS: We studied hemostasis with estimation of functional platelet activity in 49 patients with Q-fever. RESULTS: Hemorrhagic syndrome (HS) occurred in 34.4% patients with Q-fever (QF) during seasonal rise of morbidity. HS manifested with petechiae (12%), hematomas (32%), nasal bleeding (17%), stomatorrhagia (9%), melena (12%). Characteristics and duration of such symptoms as weakness (100%), myalgia (72%), arthralgia (52.9%) suggested hemocoagulatory disorders as a cause of the symptoms appearance. At the height of the disease thrombocytopenia was accompanied with inhibition of platelet aggregation activity, but regression of the clinical symptoms was associated with an increase in platelet count and platelet hyperaggregation. Fibrinogen content was elevated during hospitalization in 50% patients. CONCLUSION: Clinical manifestations of HS are typical for Q-fever prevalent in the Astrakhan Region. Hemostatic disorders because of altered functional activity of platelets were registered in all the cases and evidence for pathogenetic unbalance of homeostasis in Q-fever patients.

[Hemostatic disorders and their implication in the pathogenesis of Astrakhan rickettsial fever].

AIM: to define a role of hemostatic disorders in the pathogenesis of Astrakhan rickettsial fever (ARL). SUBJECTS AND METHODS: Platelet functional activity and plasma hemostatic parameters were studied in 89 patients of moderate ARL. RESULTS: The clinical manifestations of hemostatic disorders at the height of ARL were characterized by the appearance of typhoid maculopapular rashes in 91.4% of the patients, solitary elements of which were transformed to petechiae in 20% of cases. At convalescence (on day 10.2 +/- 1.3 of the disease), all eruptions regressed via pigmentation. At the peak of the fever, there were nasal hemorrhages and bleedings from the sites of injections; lowered platelet aggregation was detectable in the presence of thrombocytopenia at the height. Coagulation hemostasis changes were characterized only by elevated fibrinogen levels. Increased platelet functional activity and decreased fibrinogen concentrations were observed at convalescence. CONCLUSION: The basis of the clinical manifestations of ARL is hemostatic disorders due to thrombocytopenia and diminished platelet functional activity. In early convalescence, there was improved platelet aggregatability; however, the increasing trend for the rate of aggregation and the radius of aggregates suggests a risk of thrombogenesis in convalescents, which requires their follow-up with obligatory hemostatic monitoring.

[Comparative efficacy of various methods of laser therapy in patients with acute viral hepatitis B]. / Sravnitel'naia otsenka éffektivnosti razlichnykh sposobov primeneniia lazeroterapii u bol'nykh virusnym gepatitom B.

AIM: To study response to laser therapy in different modes and effects on hemocoagulation in patients with acute viral hepatitis B (AVHB). MATERIAL AND METHODS: Of 173 patients with AVHB, 87 received only basic therapy, 28 patients received placebo (no laser radiation, only signal of the timer) and 58 patients were exposed to laser radiation (32 of them intravenously and 26 supravenously). A course consisted of 10-12 sessions, laser radiation per 1 procedure 300 and 30 mJ, respectively. In addition to routine examinations, hemocoagulation was studied (platelet aggregation and desaggregation, electrocogulogram). RESULTS: Intoxication, hemorrhagic phenomena, jaundice, infusion therapy, hospital stay were shorter in AVHB patients exposed to laser therapy. Mode of action (intra- or supravenous) was insignificant. CONCLUSION: Laser therapy normalizes hemostasis and platelet function. Clinical effectiveness of laser was the same in both modes.

[Autoantibodies to the thrombocytes and erythrocytes in HIV-infected patients]. / Autoantitela k trombotsitam i éritrotsitam u bol'nykh VICh-infektsiei.

In 48 patients with HIV infection were tested for the presence of autologous and allogenic antibodies to red blood cells with the use of Coombs' direct and indirect tests. 18 HIV-infected patients had IgG antibodies to thrombocytes, circulating in the blood (detected by the method of EIA) and bound to thrombocytes (detected by the method of RIA). In 5 out of 48 patients Coombs' direct test yielded positive results with red blood cells. 6 out of 18 examined patients had an elevated content of thrombocyte-bound antibodies. The presence of cross reactions between gp120 of human immunodeficiency virus and gp3a thrombocytes led to the formation of antithrombocyte antibodies and, consequently, to a decrease in the number of thrombocytes.

[The effect of immunoglobulin on hemostatic function in patients with HIV infection]. / Vliianie immunoglobulina na sostoianie gemostaza u bol'nykh VICh-infektsiei.

The influence of immunoglobulin for intravenous injection on the state of cell- and plasma-mediated elements of hemostasis in patients with HIV infection, treated with immunoglobulin (Ig) in connection with the presence of secondary diseases of bacterial nature and having thrombocytopenia, was analyzed. After two injections of 50.0 ml of Ig to patients with HIV infection and thrombocytopenia a rise in the count of blood platelets in 80% of cases; this rise reached its maximum on day 7-10 after the beginning of treatment and was retained 1-3 months later in most patients on the level of healthy persons. Under the influence of Ig the aggregation capacity of thrombocytes increased mainly in persons with the initially low function of blood platelets. The introduction of Ig did not perceptibly influence the capacity of thrombocytes for endo-exocytosis, the aggregation activity of red blood cells, as well as the plasma-mediated element of hemostasis.

[The thrombocytic link in hemostasis and the immunity system of patients with HIV infection]. / Sostoianie trombotsitarnogo zvena gemostaza i sistemy immuniteta u bol'nykh VICh-infektsiei.

To find out possible relationships between disturbances in the thrombocytic element of hemostasis and in the immune system (the count of lymphocytes CD4, the concentration of IgG, the content of circulating immune complexes), 18 adult patients with HIV infection were examined, and in 8 of them thrombocytopenia was diagnosed. 10 patients without thrombocytopenia formed the control group. The study revealed that with the development of thrombocytopenia in patients with HIV infection the aggregation capacity of their blood platelets decreased, which correlated (p < 0.01) with a decrease in the count of lymphocytes CD4; this was indicative of the progress of immunodeficiency.

[Disorders in the plasma and cellular hemostatic components of patients with HIV infection]. / Narusheniia v plazmennom i kletochnom zvene gemostaza bol'nykh s VICh-infektsiei.

Plasmic and platelet components of hemostasis were investigated in 100 HIV-infected subjects. Its degree depended on the infection stage and associated opportunistic infections. The key factor in pathogenesis of hemocoagulatory disorders is reduced count, abnormal function and morphology of platelets. A direct relationship exists between the number of CD4-lymphocytes, a decline in the number and functional activity of platelets. Intravenous injection of immunoglobulin made in Russia as an adjuvant to combined therapy of HIV-infected subjects contributes to recovery of platelet count and aggregation.

[Hemostatic disorders in patients with HIV infection]. / Narusheniia v sisteme gemostaza u bol'nykh s VICh-infektsiei.

Impaired hemostasis was studied in 50 adult patients with HIV infection. The blood coagulative potential, the number and functional activity of platelets were examined. Platelet aggregation and secretion were shown to change earlier than thrombocytopenia developed and clinical signs of HIV infection appeared. The disturbance in the plasma section of hemostasis are due to concurrent opportunistic diseases and infections.

[The role of thrombocytes in blood coagulation disorders in infectious pathology]. / Rol' trombotsitov v koaguliatsionnykh narusheniiakh pri infektsionnoi patologii.

Platelets play the leading role in circulatory disorders seen in patients with infectious diseases. Endotoxinemia leads to platelet activation which shows up by the transformation of platelet forms from disk-shaped to spheroidal and by changes in aggregation and secretion. The degree of those changes correlates with the disease gravity. Experimental endotoxinemia (in vivo and in vitro experiments) demonstrated the same changes in the morphofunctional properties of platelets together with a possibility of correcting circulatory disorders by blockers of prostaglandin biosynthesis, such as indomethacin++, trental and emoxipine.

[The thrombocyte-activation factor and endotoxin-induced thrombocyte activation]. / Faktor aktivatsii trombotsitov i éndotoksinindutsirovannaia aktivatsii trombotsitov.

The effect of PAF in aggregation of platelets induced by endotoxin was studied in experiments in vitro. It is indicated that in high concentration (1.10(-7)-1.10(-6) M) PAF did not affect the degree of aggregation of platelets induced by lipopolysaccharides (LPS) S. typhimurium and N. meningitidis. Successive addition to PRP LPS and PAF or joint addition of PAF and LPS did not change the degree of aggregation of each inductor or their sum. A lower concentration of PAF (1.10(-11)-1.10(-9) M) and endotoxin caused a more expressive aggregation of platelets than their successive addition. Stimulating activity of PAF on endotoxin-induced aggregation, perhaps, is caused by involvement of metabolism of arachidonic acid during blood platelets activation.

[Effect of bacterial toxins on microcirculation (experimental research)]. / Vliianie bakterial'nykh toksinov na mikrogemotsirkuliatsiiu (éksperimental'noe issledovanie).

Histological and biomicroscopic methods were used to study the effects of toxic lemic and meningococcal microbial fractions on mesenteric blood microcirculation in rats. Aggregation ability of red blood cells and thrombocytes was investigated. The sublethal dose of meningococcal toxins was shown to induce marked impairment in the blood microcirculation 30 minutes after intravenous administration. The lethal dose of lemic toxins manifests itself later (in 2-4 hours). Meningococcal toxins are characterized by the increase in the aggregation ability of erythrocytes and thrombocytes in initial observation periods; lemic toxins increase the thrombocyte aggregation and produce almost no effect on erythrocyte aggregation.

[Action of toxic staphylococcal (St. aureus) substances on the functional properties of the thrombocytes]. / Deistvie toksicheskikh substantsii stafilokokka (St. aureus) na funktsional'nye svoistva trombotsitov.

The effect of toxic substances from St. aureus on morphofunctional properties of platelets has been studied in vitro. The toxic substances have been shown to induce platelet aggregation and stimulate their secretion. The platelets are transformed from discs to spheres with small pseudopodia. It is believed that platelet aggregation and secretion play an essential role in hemostasis and microcirculation disturbances.

[Various characteristics of the thrombohemorrhagic syndrome in a generalized form of meningococcal infection complicated by toxic-infectious shock]. / Nekotorye osobennosti trombogemorragicheskogo sindroma pri generalizovannoi forme meningokokkovoi infektsii, oslozhnennoi toksiko-infektsionnym shokom.

Blood coagulation was studied in 19 patients with generalized meningococcal infection complicated by toxico-infectious shock (TIS). The outcomes were fatal in 42% of cases. Blood coagulation studies were done on days 1, 2, 3, 5-7 and 19-21 of treatment. Blood coagulability was found to be reduced drastically at the peak of disease: platelet aggregability was depressed substantially, and platelet secretory function showed profound disorders. The recovery of both plasma and platelet parameters of blood coagulation was rather slow. The magnitude of disorders may have a predictive value for the prognosis of the disease.

[Study of platelet function by quantitative determination of the fluorescence intensity of 5HT-organelles]. / Izuchenie funktsii trombotsitov metodom kolichestvennogo opredeleniia intensivnosti fliuorestsentsii 5HT-organell.

Assay of the fluorescence intensity of 5HT-organelles was performed to examine the functional properties of platelets from patients with meningococcal infection. Platelets were found to have a higher capacity for endocytosis at the height of the disease, tending to its normalization with treatment and convalescence. Incubation of donor's plasma rich in platelets with meningococcal lipopolysaccharide was discovered to lead to an appreciable increase in the absorption capacity of platelets. It is suggested that endotoxinemia is one of the factors responsible for the impairment of platelet function.