[The indices dynamics of platelet pool and the level of TGF-beta1 in different forms of acute pancreatitis].

The results of study of quantitative functional characteristics of platelets are shown in patients with acute pancreatitis. The patients (57 people) with acute pancreatitis were examined: 40 patients had a mild clinical course of acute pancreatitis and 40 patients had a severe clinical course of acute pancreatitis. The circular functional mass of platelets and the level of TGF-beta1 were determined in dynamics in patients with acute destructive pancreatitis. A correlated analysis was made among the results obtained by means of laboratory and instrumental examinations and clinical course of acute pancreatitis. It was found, that the increase of TGF-beta1 and circular functional mass of platelets in the course of several days was really a good prognostic factor of clinical course of acute pancreatitis. The data obtained showed that the changes of indices of quantitative and functional characteristics of platelets are the important pathogenetic criterion of prognosis for severity of clinical course of acute pancreatitis.

[Antithrombotic therapy in the secondary prevention of stroke].

The review is devoted to the secondary prevention of ischemic events after ischemic stroke. Recommendations for antithrombotic therapy and prolonged indirect anticoagulant therapy with INR monitoring based on evidence-based medicine of the secondary prevention of ischemic stroke and TIA are presented. Patients who do not need anticoagulants should receive antiplatelet therapy. Due to the increasing number of patients resistant to antiaggregant therapy, the rapid and adequate evaluation of platelet function is needed. Current laboratory diagnostic methods have some shortcomings and do not meet criteria of evidence-based medicine. It is necessary to improve the laboratory diagnosis with the elaboration of reliable standardized methods.

[The significance of investigation of the endothelium function in diagnosis and assessment of effectiveness of treatment of infective endocarditis].

The complex state of the endothelium function was studied in 25 patients with infective endocarditis in the preoperative and early terms after surgery. A reliable elevation of all indices of endothelium dysfunction independent of the localization of the formed heart disease was detected. Against the background of operative treatment reliable changes demonstrating an improved functional state of the endothelium were noted in the early postoperative period.

[Clinical value of allele variants of cytochrome CYP2C9 gene for anticoagulation therapy with warfarin].

Warfarin is metabolized by cytochrome CYP2C9 and its pharmacokinetic properties depend on structural polymorphisms of CYP2C9 gene. We studied frequencies of allele variants of CYP2C9 gene and associations of individual reaction to warfarin intake with genotype of CYP2C9 gene. Population frequencies of CYP2C9x1, CYP2C9x2, CYP2C9x3 alleles of CYP2C9 gene in St-Petersburg were 82.66, 11.11, and 6.32%, respectively. Carriers of CYP2C9x2 and CYP2C9x3 alleles more rapidly achieved therapeutic levels of hypocoagulation and required significantly lower weekly doses of warfarin.

[Models of inter-group difference of the homeostasis system in patients with artificial heart valves and the set of laboratory parameters]. / Modeli mazhgruppovykh razlichii sostoianiia sitemy gemostaza u bol'nykh s isskustvennymi klapanami serdtsa po kopleksu laboratornykh pokazatelei.

Patients with artificial heart valves (AHV) belong to a unique multi-component model of the homeostasis system presenting an interaction of activated coagulation processes and pharmacological effects, on the one hand, and genetic peculiarities functioning homeostatic mechanisms, on the other hand. The described method was evaluated on the basis of multi-factor mathematic analysis by information-metry. The data obtained provided for isolating the most information-dense laboratory indices and some genetic polymorphisms describing the shaping of continuous intravascular coagulation of stage III in AHV patients. The clinicians and laboratory experts are offered a practical instrument for the diagnosis (prognostication) of the above condition. It was proven as necessary to examine (by the morphofunctional method) the intravascular activation of platelets and to determine the D-dimer in the remote period after prosthesis of heart valves.

[Two approaches to correction of disturbed hemostasis in patients with mechanical artificial heart valves at the long-term follow-up]. / Dva podkhoda k korrektsii narushenii gemostaza u bol'nykh s mekhanicheskimi iskusstvennymi klapanami serdtsa v otdalennye sroki nabliudeniia.

The investigation of the hemostasis system performed in 47 patients with mechanical heart valves (MHV) at the terms of (3.50 +/- 0.25) years included 30 men and 17 women. There were 24 cases of aortal MHV and 23 cases of mitral MHV, I-II functional class (NYHA). The patients were given oral anticoagulants: phenylin to 35 patients (0.009 mg/day), varfarin to 12 patients (52.6 mg/a week). The primary examination of the patients has revealed insufficient anticoagulation protection and clinically asymptomatic permanent intravascular coagulation of the third degree (PIC-3), with the signs of activation of thrombocytic and/or coagulation link of hemostasis. It has been found that a complex assessment of the hemostasis system state including the vascular-thrombocytic link is an obligatory condition of the right choice and timely correction of the PIC-3 in patients with MHV. The methods of correction of impaired hemostasis depend on the primary involvement of the vascular-thrombocytic and/or coagulation link of hemostasis. The pathogenetically selected antithrombotic therapy for patients with MHV allows timely arrest of PIC-3 and less risk of the development of thrombosis and thrombo-embolic complications at long-term periods of observation.

[The influence of hereditary thrombophilic mechanisms on the degree of permanent intravascular coagulation in patients with artificial heart valves]. / Vliianie nasledstvennykh trombofilicheskikh mekhanizmov na stepen' postoiannogo vnutrisosudistogo svertyvaniia u bol'nykh s iskusstvennymi klapanami serdtsa.

The genotyping of 40 patients with artificial heart valves (AHV) was performed after prosthesis of the mitral and aotic valves with bicuspid AHV (Medinzh-2 and CarboMedics). The patients took phenylin and varfarin. The patients' genotype was estimated by the thrombophylic genes: factor V Leiden (FVL), prothrombin G20210A, methylene tetrahydrofolate reductase C677T, G/A--455FGB, 4G/5G PAI-1, PI A1/A2 GPIIIa. The genes determining the thrombocytic activity or the vascular wall state substantially influence the third degree of the intensity of the permanent intravascular coagulation (PIC-3) independent of the degree of correction of hemostasis of oral anticoagulants. The addition of anti-aggregants to therapy is the only that can normalize functional activity of thrombocytes in patients with AHV having such defects. The laboratory detection of the genetic defects is of great practical importance for the determination of risk groups of formation of PIC-3 and the strategy of antithrombotic protection of patients with AHV.

[Prophylaxis of thrombosis and thromboembolic complications in patients with domestic mechanical artificial heart valves (AHV) "Medinzh-2" in remote terms of observation]. / Profilaktika trombozov i tromboémbolicheskikh oslozhnenii u bol'nykh s otechestvennymi mekhanicheskimi iskusstvennymi klapanami serdtsa "MedInzh-2" v otdalennye sroki nabliudeniia.

The observation included 40 patients (20 men and 20 women) with the rheumatic heart diseases acquired at the age of (45.9 +/- 8.7) years after isolated prostheses of the aortal (n = 25) and mitral (n = 15) valves with bicuspid constructions of AHV "MedInzh-2" in remote terms in (2.52 +/- 0.48) years, I-II functional valve (NYHA). It was shown that only a permanent control not rarer than once a month and an adequate correction by means of anticoagulation and antiaggregation therapy using standard methods for patients with the bicuspid AHV made it possible to avoid the development of thromboses and thromboembolic complications during three years of observation.

[Indices of chronic intravascular hemolysis in patients with different prosthetic heart valves in long-term follow-up]. / Pokazateli khronicheskogo vnutrisosudistogo gemoliza u bol'nykh s razlichnymi konstruktsiiami iskusstvennykh klapanov serdtsa v otdalennye sroki nabliudeniia.

An examination of 153 patients with valve replacement was performed at late stages of (6.8 +/- 0.2) years, in 84 patients the mitral valve replacement (MVR) was fulfilled, in 64--the aortic replacement (AVR) and in 5--two valve replacement were performed. Higher indices of hemolysis were noted in patients with AVR, in cases of two valve replacement and in patients with the paravascular fistula. The lowest indices of hemolysis take place in patients with bileaflet prostheses (MEDING/CarboMedics, St. Jude Medical), especially in patients with AVR. The complications of intravascular hemolysis are: cholelithiasis, anemia, hemosiderosis of the kidneys, sideropenia. The timely diagnosis, treatment and prophylactics are necessary to prevent these complications.

[Rare causes of the dysfunction of mechanical bicuspid heart valves]. / Redkie prichiny disfunktsii mekhanicheskikh dvustvorchatykh klapanov serdtsa.

The authors share the observations from their cardiosurgical practice showing that one of the causes of sudden death or of rapid worsening of the state of patients with implanted bicuspid artificial valves might be their dysfunction resulting both from breakage of the hinged mechanisms of the valve with its dislocation and migration and from the disturbed mobility of the valve cusp due to a thrombus formed in the atrium. The observations show that the "ideal" construction of the valve is to be created.