[The issue of use parallelism factor method and index of circulating anticoagulant in diagnostic algorithm deficity of coagulation factors.]

The paper presents the comparative use of algorithms to identify the causes of deficiency of coagulation factors in patients with a prolonged APTT, including the definition of the index of circulating anticoagulant (ICA) and the factor-parallelism (FP) method. The results obtained in children with hereditary hemophilia and adults with acquired hemophilia. It is shown that ICA is an effective method for pre-selection of patients with hereditary hemophilia if you suspect an inhibitor to subsequent confirmation test Bethesda. The method the FP has just proved itself in the diagnosis of acquired forms of hemophilia. The use of FP method is most expedient at the stage of screening to identify inhibitors in the laboratory. Method FP loses diagnostic value if the results of the activity factor in all dilutions is close to zero, which is characteristic for individual variants of hereditary hemophilia.

[Evolution of ideas on the assessment of cardiovascular risks in the perioperative period].

Substantial advance has been made in operative surgery and anesthesiology; on the one hand, population ageing and, on the other, increasing surgical care needs make the prediction of perioperative complications an important component of the entire current model of surgical care. In the last decades, the concept of risk in perioperative medicine has been formulated; the theoretical base for a statistical description of the risk concept has been created, and different integral risk prediction models based on the risk index obtained by regression analysis have been elaborated and promoted. At the same time, none of the created models can reliably assess the risk of cardiovascular events associated with surgical intervention and predict the probability of poor clinical outcomes with a high degree of accuracy.

[Changes in plasmic and platelet hemostasis in patients with chronic renal failure in hemodialysis].

Plasmic and platelet components of hemostasis were examined in 50 patients with terminal chronic renal failure (CRF) aged 23 to 67 years and 30 healthy controls of the same age. A plasmic hemostasis component was studied basing on 11 parameters of coagulogram. A platelet hemostasis component was studied by platelet aggregation: spontaneous and induced by ADP (in concentration 1.25, 2.5 and 5.0 mkg/ml), collagen, adrenalin and ristomycin. All CRF patients before hemodialysis had a significant alterations of 6 indices of a plasmic component of hemostasis: activated partial thromboplastic time, content of soluble fibrinmonomeric complexes, thrombine time; of 3 from 7 tests of aggregatogram (ADP, collagen, ristomycin induced aggregation). After hemodialysis severity of the above pathological shifts deteriorated (1.5 to 5 times). Thus, CRF patients on hemodialysis showed aggrevation of impairment of all hemostasis components. They are at risk of hypercoagulation, DIC-syndrome, massive thromboembolism. The above impairment of hemostasis should be considered in prescription of anticoagulant therapy to CRF patients. Monitoring of hemodialysis and adequate correction of the hemostasis system defects may contribute to improvement of quality of life of patients with terminal CRF and lowering of their mortality rate.

[Electrical instability of the myocardium in patients with acquired heart defects.].

Aim of the study was to investigate electrophysiological state of the myocardium and conduct comparative analysis of informative power of methods of dipole electrocardiography and signal averaged ECG with detection of late ventricular potentials for prognostication of ventricular heart rhythm disturbances in patients with acquired heart defects. Examination of 43 patients with acquired heart defects showed that patients with high grade ventricular extrasystoles significantly more often had late ventricular potentials, prolonged interval corresponding to maximal values of activation area, area of fresh activation, and diminished vector of repolarization acceleration and its components.

[Electrical instability of the myocardium in patients with aortic stenosis].

This review of the problems of prognostication of electrical instability of the myocardium in patients with aortic stenosis is based on recommendations of European Society of Cardiology on prevention of sudden death in patients with aortic stenosis with special emphasis on potential of noninvasive assessment of myocardial electric instability (signal averaged ECG, heart rate variability, analysis of variability of QT-interval, dipole electrocardiotopography).

[Microcirculation in hypertension]. / Sostoianie mikrotsirkuliatsii pri gipertonicheskoi bolezni.

Changes of microcirculatory vascular bed play important role in pathogenesis of essential hypertension. All components of the system of microcirculation including vessels and circulating blood are involved into pathological process. Resistance to blood flow is mostly formed in this system. Resistance depends on length, diameter of microvessels and viscosity of blood. In the process of the disease development the following signs of remodeling at the level of microcirculation emerge: decrease of density of vasculature, modification of the media/lumen ratio, increase of blood viscosity, slowing of angiogenesis, impairment of endothelial function. These phenomena can be both cause and consequence of hypertensive disease. Their heterogeneity depends on a variety of factors (duration, stage of the disease, etc.). It seems feasible to differentiate therapy in accordance with character and severity of changes in the system of microcirculation.

[The state of microcirculation in hypertensive disease (essential hypertension)]. / Sostoianie mikrotsirkuliatsii pri gipertonicheskoi bolezni.

Skin microcirculation was studied by laser doppler flowmetry in 149 patients with essential hypertension (92 men, 67 women; mean age 50.1+/-4.9 years) and in 25 normotensive controls. In patients with hypertension prevailed pathological hemodynamic types of microcirculation. Hyperemic, spastic and congestive types were found in 20.1, 23.5 and 40.3% of patients, respectively, while only 16.1% of patients had normal hemodynamic type. Moreover presence and severity of microcirculatory disorders depended on stage of hypertension and level of blood pressure. Thus, patients with essential hypertension had pronounced impairment of microcirculation caused by structural and functional changes of microcirculatory vascular bed.

[Nurse's evaluation of patients' problems as a methodological component in improvement of the quality of nursing care]. / Sestricheskaia otsenka problem bol'nogo kak metodologicheskii komponent povysheniia kachestva sestrinskoi pomoshchi.

Nurse's diagnosis is an integral part of nursing process. Currently used methods within the framework of nursing process do not fully meet the requirements to each discipline. The authors discuss an approach to nurse's diagnosis, which will create prerequisites for developing a principally new standard approach to nurse's participation from a modern viewpoint.