[Markers of coagulation and fibrinolysis in peripheral blood and in blood collected pouch of Douglas in patients with ectopic pregnancy]. / Uklad krzepniecia i fibrynolizy krwi obwodowej i pobranej z zatoki Douglasa u kobiet z ciaza ektopowa.

In cases of ectopic pregnancy a blood collected in a pouch of Douglas is a nonclotting one. It contains no fibrinogen, prothrombin, factor V and VII, plasminogen and monomers of fibrin, however concentration of D-dimers is very high. Is this solely an effect of independently occurring fibrinolysis or does coagulation accompany this process? The definite answer can not be given. Coagulation and fibrinolysis markers obtained at the same time from peripheral veins were normal.

Effect of antiproteolytic drugs: epsilon-aminocaproic acid (EACA) and aprotinin on experimental anti-GBM nephritis.

BACKGROUND: Given the evidence accrued by other authors on beneficial effect of protease inhibitors on experimental immune nephritis, and following our preliminary report on abrogation of immune glomerulopathy in the rat by antifibrinolytic and antiproteolytic drug, epsilon-aminocaproic acid (EACA), we investigated the effect of this drug on the rat autologous anti-GBM nephritis. Along with the EACA we evaluated another protease inhibitor, aprotinin, an antagonist of serine proteases. METHODS: EACA (0.3g/kg) or aprotinin (5000 kallkrein inhibition units, KIU/kg) was administered intraperitoneally (t.i.d.) from day 0 (preventive protocol) or day 3 (therapeutic protocol) of autologous anti-GBM nephritis induced in Wistar rats. Proteinuria, creatinine clearance and renal histopathology were assessed as markers of disease activity, while glomerular fibrin deposits (immunoperoxidase staining) and standard parameters of coagulation/fibrinolysis of peripheral blood enabled insight into local and systemic haemostatic mechanisms. Glomerular binding of anti-GBM antibodies (immunofluorescence) and serum titres of autologus nephrotoxic antibodies (haemagglutination assay) represented conditions of immune induction of glomerulopathy. RESULTS: Our experiments indicated that EACA, and to a lesser extent also aprotinin, are capable of preventing proteinuria (EACA, reduction by 57.6%; aprotinin, reduction by 26.8%, compared to untreated nephritic rats, day 3 post-induction) and glomerular histopathological changes, without affecting endogenous creatinine clearance, otherwise depressed in this model of glomerulonephritis. More importantly, both drugs significantly ameliorated glomerular lesions and proteinuria, even when the treatment was initiated on day 3 post-induction, after the injury has begun (EACA reduced proteinuria by 32.0%, and aprotinin reduced it by 20.9% day 7). Administration of EACA and aprotinin at doses reducing glomerular injury did not cause appreciable fibrin deposition in glomeruli of nephritic rats, nor did it modify parameters of systemic coagulation and fibrinolysis in these animals, EACA and aprotinin did not interfere with serum titres of nephrotoxic antibody, nor with the intensity of its binding to the glomerular basement membrane in vivo. CONCLUSIONS: Antiproteolytic drugs utilized in our studies exert their beneficial effect on autologous anti-GBM nephritis through interference with inflammatory phase of the disease, while sparing its immune induction and mechanisms of coagulation/fibrinolysis.

[Suppurating lesions following surgical treatment of lower limb ischemia due to atherosclerosis]. / Powiklania ropne po leczeniu operacyjnym niedroznosci tetnic konczyn dolnych z powodu miazdzycy.

Patients with suppurative lesions complicating surgical reconstruction of the arteries have been analysed. Such complications have been noted in 110 (102 men and 8 women) out of 311 operated patients. Considering the difference in the number of male and female patients, the risk of suppurative lesions complicating vascular surgery is proportional in both sexes. Thousand three hundred sixty six surgeries included: 361 recanalizations, 944 transplantations, and 61 arterial plasties. Percentage of suppurative complications ranged from 8.8% after transplantations to 9.8% after arterial plasties. More than one surgery has been performed in some patients. The risk of infectious complications has been higher in these patients. Despite antibiotic treatment suppurative infections have been noted in 108 (101 men and 7 women) out of 1244 operated patients, i.e. in 8.6%. Intravenous administration of antibiotics during surgery has proven the most effective prophylaxis. An infection of postoperative wound is the most severe local complication in vascular surgery. It has also been most frequent in the analysed group of patients, being 31.3% of all local complications.

[Test for evaluating diagnostic discriminative function for assessment of blood supply to the lower limbs in patients with atherosclerosis]. / Próba zastosowania diagnostycznej funkcji dyskrymina-cyjnej do oceny stanu ukrwienia konczyn dolnych u chorych z miazdzyca tetnic konnczyn dolnych.

Discriminative mathematical function was used for the classification of patients with atherosclerosis in the lower limbs. Considering 8 features of the blood supply to the lower limbs, 500 patients selected from the Polish centres of vascular surgery were classified according to the degree of ischemia. This mathematical analysis and classification proved to be comparable with clinical assessment. Described method is an example of the use of the mathematic tool which is particularly useful in the analysis of large groups of patients.

Human immunodeficiency virus (HIV) antibodies in patients with haemophilia and other inheritable blood clotting disorders in south west Poland (Lower Silesia region).

In order to determine the frequency of HIV antibodies among patients with haemophilia and other inheritable blood clotting disorder in the Lower Silesia region of South-West Poland, we examined a representative fraction comprising 106 patients from a cohort of 302 blood clotting disorder patients. The methods used for detecting HIV antibodies were an ELISA, the immunoblotting test ("Western blot") and an indirect immunofluorescence test. 8 patients were reactive in the ELISA, but only 2 (1.9%) patients were truly seropositive by the confirmation tests. Both patients have received imported commercial factor VIII preparation. Totally 17 patients have been treated with imported factor VIII, thus 12% (95% confidence limits: 1.5-36.5%) of these were seropositive. This figure, which is lower than figures obtained from the USA and Western Europe, is probably due to far less intensive treatment of the patients. None (95% confidence limits: 0-4.1%) of the patients solely treated with blood transfusion and locally produced preparation was HIV antibody positive. These results indicate a low prevalence of HIV infection in this region of Poland but are, on the other hand, a strong argument for an introduction of HIV antibody screening of blood donors to maintain these favourable condition.