[Efficacy and safety of oral anticoagulant "Rivaroxaban" in patients after implantation of a cava filter]. / Éffektivnost' i bezopasnost' oral'nogo antikoagulianta «Rivaroksaban¼ u patsientov posle implantatsii kava-fil'tra.

OBJECTIVE: preliminary assessment of efficacy and safety of prolonged anticoagulant therapy with Rivaroxaban in patients after implantation of a cava filter. MATERIAL AND METHODS: this prospective clinical study included a total of 30 patients presenting with thrombosis of deep veins of lower limbs of proximal localization with signs of flotation of the thrombus and free apex more than 4 cm in length. The patients received a temporal cava filter later on not removed for various reasons. After implantation of the cava filter the patients were given therapeutic doses of low molecular weight heparins during 48 hours followed by switching to standard therapy with vitamin K antagonists or to an alternative regimen of treatment with new anticoagulant Rivaroxaban (15 mg twice daily for the first three weeks, then 20 mg once daily during the whole period of follow up). Rivaroxaban (Study Group) was given to 15 patients (8 men and 7 women aged from 35 to 87 years, mean age 65.5±16.2) having from one to six (averagely 2.9±1.4) individual risk factors for the development of venous thrombosis. Each of them had a matching patient included in the control group, receiving conventional therapy with vitamin K antagonists and corresponding by age (± 5 years), gender, and the total number of individual risk factors (± 1). The maximal duration of follow up amounted to 1 year. RESULTS: the cava filter according to the findings of ultrasound duplex scanning was patent during the whole follow-up period in 100% of patients in the both groups. No relapses of venous thromboembolic complications were registered in any patient. The cumulative frequency of the development of haemorrhagic complications amounted to 13% for the Study Group patients and to 20% for the Controls, with the differences being statistically significant. In the control group haemorrhagic complications were of more severe forms: one intracranial haemorrhage and two intracutaneous haemorrhages (in the Study group - one intracutaneous haemorrhage and one gingival haemorrhage). CONCLUSION: the study showed possibilities and safely of using new oral anticoagulant Rivaroxaban in patients with the implanted cava filter. The obtained pilot findings require further confirmation in randomized clinical studies.

[Treatment of acute deep vein thrombosis with new oral anticoagulant rivaroxaban: the first experience].

The aim of the study was to make a preliminary assessment of the efficacy and safety of acute deep vein thrombosis (DVT) prolonged treatment with new oral anticoagulant rivaroxaban. Materials and methods. It was a prospective observational study included patents with instrumentally verified DVT admitted to the Department of Vascular Surgery of the Clinical Hospital n.1 President's Administration of Russian Federation. All patients were administrated to the initial treatment with low-molecular weight heparins during first 24-48 hours followed by overlapped therapy with vitamin-K-antagonists. Patients who rejected a standard therapy were offered an alternative oral anticoagulant rivaroxaban: 15 mg bid during first 3 weeks followed by 20 mg qd. The duration of therapy varied from 3 to 12 month and more depend on localization and clinical provocation of the thrombosis. The dynamic control was performed on 3rd, 6th, 9th and 12th month. The endpoints of the study were recurrent DVT verified with duplex ultrasound or pulmonary embolism (PE) and hemorrhagic complications. In the study were enrolled 30 patients aged 27-87 years (mean age - 59.0±16.8), 13 men and 17 women who had from 0 to 6 individual risk factors (average - 2.4±1.6). In 33.3% cases DVT was clinically provoked and in 66.7% - unprovoked. Results. There were no recurrent DVT or PE observed. Cumulative rate of bleeding was 13.3% (95% CI: 1.2-25.5%): 6.65% (95% CI: 1.8-21.3%) - minor bleeding , that did not need drug withdrawal or extra visit to the doctor, and 6.65% (95% CI: 1.8-21.3%) - clinically significant bleeding, that needed an unscheduled visit to the doctor, the temporary interruption of the therapy or medical intervention. Major bleeding were not identified. Bleeding were presented as hematuria, petechial skin hemorrhages and epistaxis. Conclusion. The study demonstrates feasibility and safety of the new oral anticoagulant rivaroxaban application in the prolonged treatment of acute DVT.

[Role of compression bandage with elevated level of pressure in decreasing incidence of venous thrombosis in high-risk patients].

UNLABELLED: The study was aimed at assessing efficacy and safety of using graduated compression bandage with the level of pressure in the area of the middle ankle amounting to 20-40 mm Hg as compared to the conventional profile (10-20 mm Hg in the ankle area) in the composition of comprehensive prevention of postoperative venous thromboembolic complications (VTEC) in patients of a high-risk group. For this purpose we carried out a prospective randomized clinical study including a total of 100 surgical patients (general surgery, neurosurgery) from a group of high risk for the development of VTEC with the presence of 3 and more conditions predisposing to venous thrombosis. All patients were subdivided into two subgroups 50 patients each. Patients in both groups received anticoagulants in standard preventive doses from the first day after surgery or in the remote period. The Study group patients were treated by applying on the ankle a bandage of medium distensibility with the target pressure in the ankle area of 20-40 mm Hg measured by means of a portable manometer. The control group patients were treated by a similar bandage applied onto the ankle and femur with a pressure of 10-20 mm Hg. In all cases a special lining material was placed under the bandage. With the purpose of active screening of postoperative VTECs, prior to the beginning of the study and then each 3-5 days we performed ultrasound angioscanning and in case thrombosis was revealed we performed static perfusion scintigraphy of the lungs and/or echocardiography for verification of pulmonary embolism. The patients who died were subjected to post-mortem examination. We also assessed the frequency of correcting the bandage on the femur and crus. RESULTS: The incidence rate of postoperative venous thrombosis in the Study Group amounted to 16.0% (95% CI: 5.8-26.2%) and in the Control Group 36.0% (95% CI: 22.7-49.3%, p=0.039), with no significant differences in the incidence of proximal thrombosis or pulmonary embolism revealed. Maximal reduction of the development of venous thrombosis was revealed in patients with lower-limb paralysis amounting to 69.5%. The frequency of the development of cutaneous lesions under the bandage did not differ significantly between the subgroups, being 8% and 12%, respectively. The total number of corrections of the compression in the Control Group was significantly higher, amounting to 0.64±0.23 time a day versus 0.32±0.05 t/d (p<0.0001). CONCLUSION: The use of an elevated compression profile makes it possible to decrease the incidence of postoperative VTECs, especially in patients with palsy, not increasing the rate of cutaneous lesions under the bandages. Femoral compression provides no additional reduction of the incidence of thrombosis but creates an additional necessity of correcting the bandages.

[The use of new sets and medical kits by the medical service of the Armed Forces].

Taken to supply in the Armed Forces of the Russian Federation and included in the modern regulating documents new sets and medical kits are a crucial element of the complete-standard-issue equipment. For the military unit of medical service provided 12 sets and medical kits united into 2 classification groups. They allow medical service to perform any surgical interventions and medical procedures in the military echelon in accordance with modern approaches to health care and treatment of the wounded in wartime, in armed conflict and the elimination of the health consequences of emergencies in peacetime.

[Nutritional support in surgical treatment of patients with post-gastroresection and post-gastrectomy syndromes].

The aim of the research determine the character and peculiarities of nutritional support in surgical treatment of patients with gastroresection--and total gastrectomy syndromes. Analyzed are the results of the evaluation nourishing status of 68 patients who have had a resection intervention on the stomach. It was noted that the 26.5% of patients with clinical manifestations of diseases of operated stomach arise sub- and decompensated forms of disorders metabolism and nutrition, entailing numerous violations of homeostasis and requiring compliance with reconstructive surgical interventions. We studied the results of the implementation of the reconstructive operations with the formation of functionally active (see text for symbol) in 18 patients, suffering from the disease of stomach operated on. It is proved, that the rational nutritional support in the perioperative period allows to avoid gross violations of metabolism and provides a reasonably good compensation digestive function, significantly improving the quality of life of this category of patients.

[Autochthonous probiotics in prevention of infectious and inflammatory diseases of a human in the altered habitats].

Dysbiotic shifts in intestinal and pharyngeal microflora were studied in 22 normal volunteers in 9-, 14-, 105- and 520-d chamber experiments simulating some of the spaceflight factors. Two preparations were administered to prevent pharyngeal and intestinal dysbiosis: oral dry probiotic based on indigenous intestinal Enterococci and topical collagen-immobilized Lactobacterin based on indigenous intestinal Lactobacilli. Topical autopmrobiotic lactobacterin reduced the growth of opportunistic pathogens in the throat during the experiments. Oral autoprobiotic based on Enterococci reduced the content of intestinal opportunistic pathogens, supporting the high level of protecting microflora. Most of autostrains are free from pathogenicity factors, nevertheless, implementation of genetic testing of indigenous strains are reasonable.

[Prognosis of the immediate period of an ischemic stroke].

We investigated 342 patients with clinical outcome of a disease and 61 died patients with acute disease. With the help of the method of representative sample of patients with an ischemic stroke the clinical picture and data about tool methods of research are investigated. We received solving rules of forecasting of favorable and adverse outcomes ischemic stroke with use of the discriminative analysis.

[Haemodynamic and clinical efficacy of electric muscular stimulation of the venous outflow in prevention of postoperative venous thromboembolic complications].

The present clinical and experimental study was carried out in order to evaluate efficacy of electrical stimulation of the crural muscles with the purpose of preventing postoperative venous thromboembolic complications. At the first stage by means of ultrasonographic angioscanning in apparently healthy volunteers (n=21) we evaluated the linear velocity of blood flow on the popliteal vein on the background of using myostimulation and compression bandage with various levels of pressure applied either separately or in a combination with each other. It was revealed that electrical stimulation of the crural muscles led to a 2.8-4.5-fold increase in the peck velocity of blood flow, while the compression decreased the parameters of the venous outflow both at rest and during muscular contraction. By means of theoretical calculations it was determined that an optimal compression profile for a combination with electrical stimulation is a pressure under the bandage equalling 20-40 mm Hg, providing substantial acceleration of the venous outflow with the laminary blood flow preserved. At the second stage we assessed efficacy of comprehensive prevention of venous thromboembolism with the use of electromyostimulation, the respective compression bandage and direct anticoagulants in surgical-profile patients from a high-risk group (n=90) by means of ultrasound screening of the venous system during the whole postoperative period. When myostimulation was used in the regimen of 3-5 procedures a day, the frequency of venous thrombosis amounted to 40% (n=10) and did not significantly differ from that in patients not subjected to myostimulation (25%, n=40). When myostimulation was used in the regimen of 5-10 procedures per day, the frequency of venous thrombosis turned out to be considerably lower (2.5%, n=40). A conclusion was made on efficacy of using this method in the examined group of patients.

[Atrial fibrillation registered for the first time: characteristics of clinical course, treatment, prognosis].

To study the clinical presentation of the first episode of atrial fibrillation (AF), treatment tactics and its compliance with current recommendations, features of the further clinical course and prognosis in patients with AF we performed a retrospective study on data of Polyclinic No 1 of the General Management Department of the President of RF . We analyzed data from 58 patients (36 men, 22 women) from January 2009 to September 2011 inclusive. The first episode of AF was recorded in the age from 48 to 90 years (in 39.7% of patients - aged 80 to 90 years old), mostly had paroxysmal character (84.5%), in 82.1% of cases was accompanied by marked clinical symptoms: sense of disruption of the heart (50%), feeling short of breath (28.6%), weakness (17.9%). In 87% of cases clinical symptomatology required calls for medical emergencies. In 42.9% of cases uncontrolled hypertension was possible predisposing factor for developing AF. Paroxysmal AF moved to constant in 38.8% of patients during the period from 1 year to 18 years. Due to the high risk of thromboembolic complications (2 to 5 on a scale of CHADS2), after the detection AF warfarin was shown to 96.6% of patients, because of the high risk of bleeding in practice was appointed only 37.9%. Complications of therapy in the form of bleeding were 9.1%. Tactics of rhythm control by antiarrhythmic drugs I and III classes has remained in 36.7% of patients with paroxysmal AF. -adrenoblockers were constantly taken by 63.3% of the patients using antiarrhythmic drugs I and III classes for relief of arrhythmia during her recurrence (the strategy of "pill in pocket").

[Prognostication of the probability of ischemic stroke].

The study included 405 patients with ischemic stroke and 35 ones with transitory ischemic attack. Predictors of stroke are considered and approaches to its prognostication proposed The results can be used to distinguish patients in need of preventive therapy of ischemic stroke.

[Medical service tasks for providing for toxicological and radiation protection of servicemen].

Medical assurance of toxical-radiologic defense intends effectuating of complex of measures, oriented to preservation of life, health and military-professional working capacity in conditions of factors of chemical and radiological nature in war and piece. It demands the realizing of right medical measures, based on knowledge by military physicians of all professions about peculiarities of effectuating of chemical agents and sources of ionization radiation on person's health. A qualified preparation in questions of toxicology and radiology permits create and use in practice of military health-care an effective system of medical assurance of toxical-radiologic defense of service men.

[Organization of medical support of troops in the course of Georgia peace enforcement operation].

In the course of operation the medical armed units and institutes of permanent readiness realized the buildup of forces and measures of the medical service. Supplementary were provided: to enforce the 236th military hospital (Vladikavkaz)--group of medical enforcement from Main and central military hospitals; to enforce the 1602nd regional hospital (Rostov-on-Don)--brigade of specialized medical aid of MMA of Kirov S.M.; the 183rd separated medical group of special purpose (semegosp SP) (PUMR). From 14 to 28 of August 2008 the 529 semegosp SP provided the medical aid to 456 patients (350 persons of them were servicemen), 221 persons were hospitalized, 136 persons were evacuated. Additionally an autobandaging room was established in the structure of surgical group. From 14 to 28 of August 2008 the 183 MU SP provided the medical aid to 115 patients (104 persons of them were servicemen), 32 persons get a stationary treatment, 21 persons were hospitalized, 25 persons were evacuated, 8 persons were discharged. Generally, medical service, which took party in operation of Georgia peace enforcement, realized all missions.

[Main directions of realization of strategy of social development of the Armed Forces of Russian Federation up to the 2020th year].

Latter years the president and the government more and more pay attention to the questions of social evolution of the Army and Navy, augmentation of the level of social protection of military staff, discharged and members of their families. But a great number of problems of military-social sphere are not yet resolved. Presented Strategy is a complex document of long termed character. The strategy defines concrete purposive results in the sphere of social evolution of the Armed Forces for the period up to 2020th year; check list of the main measures and the mechanism of the control of their's realization. In the frames of Strategy there was elaborated a such program, as "Improvement of medical supply of the Armed Forces for the period 2008-2020", which includes 15 subprograms: "AIDS-infection in the Armed Forces", "Tuberculosis in the Armed Forces", "Prevention and treatment of cardiovascular diseases in the Armed Forces", "Improvement of material-and-technical base of military-medical units", "Health survey and propaganda of orthobiosis", "Prophylaxis of dental diseases", and others. Now-days there was created a working group, it's continues the elaboration of the plan of realization of measures of Strategy.