[Systemic components of pathogenesis of lower-limb atherosclerotic gangrene].

A prospective controlled study was carried out in a total of thirty-four patients presenting with atherosclerotic gangrene ofthe lower extremities. Surgery was preceded by studying haemostasiograms, biochemical parameters and indices of the functional system of detoxication, level of acute-phase proteins, cytokines, stress enzymes. It was determined that irreversibility of tissue damage in atherosclerotic gangrene of the lower limbs results in the development of the main pathogenetic phenomena of systemic impairments, i.e., stress reactions of the neuroendocrine system, systemic inflammatory response, activation of intravascular blood microcoagulation, oxidative stress, crash-like syndrome, autogenous intoxication, latent organic dysfunctions, forming in the aggregate a pathogenetically vicious circle of impairments with local manifestations, pain reaction, and various critical complications of this nosological entity.

[Early postoperative systemic inflammatory response in patients with lower extremity atherosclerotic gangrene].

A prospective controlled study was conducted in 30 patients with lower extremity atherosclerotic gangrene. Their mean age was 66.1 +/- 9.0 years. Examinations were made before and after high leg amputation. The investigators analyzed the following markers of a systemic inflammatory reaction (SIR): IL-1beta, 6, 8, 10, TNF-alpha, and L-2r. The concentrations of myoglobin (a marker of tissue damage), cortisol and blood glucose (markers of sympathoadrenal system activation), D-dimers (a marker of disseminated intravascular coagulation), C-reactive protein (CRP), lipopolysaccharide-binding protein, and fibrinogen were also measured. The signs of muscle damage (such as elevated myoglobin concentrations), stress, and CRP were detected in patients with atherosclerotic gangrene in the pre- and postoperative periods. The risk of pyoinflammatory complications in the immediate postoperative period may be predicted from the higher levels of acute-phase proteins (CRP), proinflammatory cytokines (IL-6), and myoglobin.

[Activation of intravascular microcoagulation of blood in patients with atherosclerotic gangrene of the lower limbs].

A prospective study was carried out in order to investigate the system of haemostasis in a total of sixty patients presenting with atherosclerotic gangrene of a lower extremity who were then subjected to high amputation. The operative intervention was preceded and followed by determining the following parameters: antithrombin III (AT-III), fibrinogen (FG), thrombin time (TT), activated partial thromboplastin time (APTT), prothrombin time (PT), the number of the soluble fibrin-monomeric complexes (SFMC) and D-dimers, euglobulin fraction clot lysis time, the amount and aggregation activity of blood platelets. The findings obtained while studying haemostasis in patients with irreversible ischaemia of the lower limbs demonstrated activation of the intravascular microcoagulation of blood prior to the operation. The immediate postoperative period was marked by preservation of the shortened APTT, high concentration of fibrinogen, elevated euglobulin clot lysis time, high concentrations of SFMCs and D-dimers of blood, which created conditions for the development of thrombotic complications even in a relatively stable course of the postoperative period. The authors underline the necessity of determining an optimal mode of prescribing and administering appropriate doses of direct anticoagulants in the early and immediate postoperative period, as well as that of making an appropriate decision of whether or not to use indirect anticoagulants for correction of haemostasis in these patients during the remote postoperative period.

[The concept of the development of multiple organ failure in a model of gestosis]. / Kontseptsiia razvitiia poliorgannoi nedostatochnosti na modeli gestoza.

Mechanisms of development of multiple organ failure (MOF) in gestosis have been studied. Analysis of the findings of examinations of 95 women with gestosis hospitalized in intensive care wards of Institute for Maternity and Neonatality Protection demonstrated that elements of the systemic inflammatory response syndrome (SIRS) underlie the development of MOF syndrome in gestosis, which can be diagnosed starting from early terms of gestation.

[Prognosis, monitoring and intensive therapy in the prevention of the development of hemorrhagic complications in labor]. / Prognoz, monitoring i intensivnaia terapiia v profilaktike razvitiia gemorragicheskikh oslozhnenii v rodakh.

Blood clotting system has been studied over the course of pregnancy. The detected close correlations between hemostasiograms and labor hemorrhages suggested the possibility of predicting hemorrhagic complications. Based on informative signs, the authors formulate the rules for predicting hemorrhagic complications of labor starting from the first trimester and define the algorithm of monitoring the hemostasis system. Application of this system helped decrease the incidence of labor hemorrhages by half by means of appropriate preventive therapy.

[Mathematical evaluation of methods of determining the fibrinolytic activity of whole blood]. / Matematicheskaia otsenka metodov opredeleniia fibrinoliticheskoi aktivnosti tsel'noi krovi.

Mathematical analysis of the adequacy of laboratory tests for estimation of blood fibrinolytic activity, routinely used in practical obstetrics, has shown that any of the known methods may be used in healthy nonpregnant and pregnant women for the diagnosis of fibrinolysis system abnormalities. To diagnose such conditions in women with pathologic pregnancy two laboratory tests should be employed with due consideration for their impact.

[Pre-clinical diagnosis of toxemia in the second half of pregnancy in a day-care hospital]. / Doklinicheskaia diagnostika toksikoza vtoroi poloviny beremennosti v usloviiakh odnodnevnogo statsionara.

In this study +the purpose to improve diagnostic precision in preclinical forms of late toxemia, the central and peripheral circulation and hemostasis have been evaluated in women during their four day-stay visits scheduled for a pregnancy. Transition of normal pregnancy to "++pre-toxemic" was most commonly seen in the second trimester. Platelet counts and levels of fibrinogen and beta-fibrinogen proved to have the highest predictive value. A decision-making rule was designed for categorization of pregnancies into normal and "++pre-toxemic" and was found to have a 90% efficiency.

[Tisamide in the complex treatment of tuberculosis]. / Tizamid v kompleksnoi terapii tuberkuleza.

The outcomes of tisamid treatment of newly diagnosed patients with bacillary pulmonary tuberculosis were analysed. To estimate the efficacy of tisamid and its administration indications, chemotherapy of the patients was performed with the use of two therapeutic regimens. Isoniazid, rifampicin and streptomycin (or ethambutol) were given to 73 patients, while other 72 ones were treated with the same drugs plus tisamid. The patients in each group were subdivided into slow, rapid and homozygotic (the most rapid) acetylators. Tisamid, when prescribed to newly-discovered patients with destructive tuberculosis, accelerates recovery, by excluding the risk of a hepatotoxic action. Tisamid in a combined treatment with isoniazid, rifampicin and streptomycin is mostly recommended for patients with a rapid acetylation phenotype, i.e. the cases for whom a short-term chemotherapy is possible.