[Use of local thrombolysis in patients with massive pulmonary thromboembolism and moderate-to-severe pulmonary hypertension]. / Primenenie lokal'nogo trombolizisa pri massivnoi tromboémbolii legochnoi arterii s umerennoi i vyrazhennoi legochnoi gipertenziei.

Presented herein are the results of treating a total of 110 patients with acute massive pulmonary thromboembolism. The patients included in the study were divided into 2 groups depending on the degree of severity of pulmonary hypertension. All patients underwent interventional treatment, i.e., endovascular mechanical fragmentation with local thrombolysis. Both short- and long-term outcomes were then analysed. Performing local thrombolysis made it possible to achieve regression of clinical manifestations of acute respiratory insufficiency in more than 98% of patients. Stabilization of the clinical condition in the early postoperative period was accompanied by improvement of haemodynamics of the right heart in the remote terms of follow up after the intervention. There were 2 (1.8%) lethal outcomes resulting from progression of acute cardiovascular insufficiency. Clinically significant haemorrhage was observed in 1 (0.8%) case and was successfully arrested by conservative therapy. It was shown that local thrombolysis contributed not only to improving perfusion of the lesser circulation, a reduction of pressure in pulmonary arteries and the right heart, but also to a decrease or normalization of the linear dimensions of the right auricle and right ventricle, as well as prevented the formation of chronic postembolic pulmonary hypertension in more than 90% of patients. It was also demonstrated that while performing this type of treatment, the initial level of pulmonary hypertension did not influence either the prognosis or the outcome of the disease.

Biochemical markers in blood serum of patients undergoing various methods of carotid endarterectomy. / Biokhimicheskie markery syvorotki krovi pri razlichnykh metodakh karotidnoi éndarteréktomii.

The authors studied the concentration of CRP, sE-selectin, sP-selectin, sICAM-1, sICAM-3, sVCAM-1, sPECAM and endothelin-1 in blood serum of patients presenting with stenotic lesions of carotid arteries and undergoing various methods of carotid endarterectomy (CEAE): eversion CEAE (Group I) and CEAE using a xenopericardium patch (Group II). Within the time frame of the study, patients in both groups were found to have an elevated CRP level in the early postoperative period, having returned to the baseline values at 6 postoperative months, as well as an increase in the concentration of endothelin-1 at six months after surgery and a decrease of the sE-selectin concentration in the early postoperative period. The level of sP-selectin in Group II patients was noted to increase considerably six months after correction of stenosis. The content of sICAM-1 and sVCAM-1 did not differ in the early postoperative and baseline periods, and was noted to decrease 6 months after the operation. Group II patients demonstrated a decrease in the sPECAM concentration during postoperative day one, followed by returning to the initial values six months after CEAE. The above-mentioned biochemical markers may be used during the postoperative follow-up period for early detection and appropriate correction of endothelial dysfunction and hyperplasia of the intima of the zone of reconstruction.

[Influence of remote ischemic preconditioning on brain injury markers dynamics during cardiopulmonary bypass].

INTRODUCTION: Remote ischemic preconditioning has gained clinicians' attention as a technique to protect the heart in patients undergoing cardiac surgery under cardiopulmonary bypass. While experimental data report neuroprotective properties of remote ischemic preconditioning, we failed to find any clinical studies investigating its effects on neurologic outcome in cardiac surgery. PURPOSE OF THE STUDY: This prospective randomized placebo-controlled study was undertaken with the aim of elucidating the role of remote ischemic preconditioning for neuroprotection in cardiac surgery. PATIENTS AND METHODS: 88 patients with coronary heart disease scheduled for on-pump coronary bypass grafting surgery were randomized to receive either remote ischemic preconditioning or control. We studied S100B peptide and neuron-specific enolase to assess neurological damage. Psychophysiological tests were employed to investigate cognitive function after surgery. RESULTS: The perioperative dynamics of S100B and neuron-specific enolase followed similar patterns in both groups throughout the observation period. At the end of surgery, level of S100B was significantly higher in the preconditioning group as compared to controls--0.58 (0.33-0.65) vs. 0.34 (0.23-0.42) mcg/l, p

[Pulmonary artery thromboembolism on the background of hyperhomocysteinemia].

The article provides a detailed description of a clinical case report of acute massive pulmonary artery thromboembolism (PATE) in an elderly female patient. She was diagnosed with a carrier state of polymorphism of genes associated with impairment in the folate cycle MTHFR:677 - TT, MTRR:66 - AG and polymorphisms associated with disordered blood coagulation system F13 - GT; ITGB3:1565 - TC; SERPINE1 (PAI-1):675 - 4G4G. She was also found to have hyperhomocysteinemia - 67.1 µmol/l and hyperaggregation syndrome. Timely prescribed antithrombotic therapy and an agent containing in its base folic acid, vitamins B6 and B12 after surgical intervention in the scope of endovascular recanalization of pulmonary arteries and additional thromboembolic therapy resulted in a favourable outcome.

Association of folate metabolism gene polymorphisms and pulmonary embolism: A case-control study of West-Siberian population.

INTRODUCTION: Our objective was to investigate the association between gene polymorphisms of folate cycle (MTHFR 677 C>T, MTHFR 1298 A>C, MTR 2756 A>G, and MTRR 66 A>G) and the risk of pulmonary embolism (PE) in a case-control study. MATERIALS AND METHODS: 177 PE patients (87 women and 90 men) were compared to a healthy control group (461 people, 123 women, 326 men). All of them are residents of Novosibirsk region. SNPs were genotyped by allele-specific PCR. RESULTS: The age distributions of our male and female patients were found to be significantly different. For men, the distribution has two maxima, whereas for women it has only one maximum, which is between the two. This fact stimulated us to perform a sex-specific analysis. No statistically significant difference has been found between distributions of the three genes in our PE patients and healthy controls. However, it was discovered that the TT genotype of MTHFR: 677 C>T polymorphism in men increases the risk of PE in comparison to controls. In fact, the difference increases in the age group over 45years. Also, AA genotype of MTRR 66 A>G polymorphism in women below 45years decreases the risk of PE. The sex-specific multiple linear regression analysis gave us estimates of the relative PE risk associated with MTHFR 677 C>T, F2: 20210G>A (Prothrombin), and F5: 1691G>A (Leiden) mutations.

[The flow cytometry in diagnostic of sepsis in children of first year of life with congenital heart disease and operated in conditions of artificial circulation].

The study was organized to evaluate sensitivity and specificity of CD64 index and relative amount of HLA-DR+ monocytes in diagnostic of sepsis in children of first year of life after surgery correction if congenital heart disease in conditions of artificial circulation. To detect CD64 index the kit Leuko64 (Beckman Coulter USA) was applied. The relative amount of HLA-DR+ monocytes was measured by flow cytofluorimeter Navios (Beckman Coulter, USA) using combination of monoclonal antibodies CD14-APC, HLA-DR-PacificBlue, CD45-KrOr. The results of study established that CD64 index in the group with confirmed or supposed sepsis consisted 2.29 (1.96:3.32) that statistically is reliably higher (p = 0.001) than in group without sepsis. The study established no statistically reliable differences in concentration of C-reactive protein in blood serum (p-0.123), absolute amount of leukocytes in peripheral blood (p = 0.128), relative amount of HLA-DR+ monocytes (p = 0.789). It is demonstrated that value of CD64 index higher than 2.00 increases the risk of development of sepsis up to 9.4 times and can be used as a diagnostic criterion of sepsis (AUC = 0.895) with sensitivity up to 80% and specificity up to 90%. The negative prognostic significance of CD64 index and content of procalcitonin in relation to development of sepsis in children of first year of life operated in conditions of artificial circulation amounted to 74% and 76% and 77% and 64% in case of positive prognostic significance correspondingly.

[Functional state of right ventricular myocardium in patients with acute pulmonary embolism before and after thrombolytic therapy].

We present in this paper results of assessment of functional state of right ventricular (RV) myocardium in 38 patients with acute pulmonary embolism (PE) before and after endovascular recanalization of pulmonary arteries supplemented with thrombolytic therapy. According to echocardiography data RV dysfunction was detected in 60.5% of cases, while an elevated concentration of brain natriuretic peptide (BNP) in blood plasma was observed in all patients. None of the patients had elevated level of troponin I. An increased concentration of BNP in blood plasma with normal troponin level in patients with acute PE was indicative of a hidden RV dysfunction due to its dilatation, acute volume or pressure overload without evidence of myocardial damage. Implications. All patients with acute pulmonary embolism who are hemodynamically stable, but have elevated levels of plasma BNP should undergo thrombolytic therapy (TLT) with the aim of early recanalization of pulmonary arteries and elimination of RV dysfunction. Early thrombolytic recanalization of the pulmonary arteries not only provides restoration of impaired RV function, but also prevents formation of post embolic chronic pulmonary hypertension and improves clinical prognosis.

[Immunological aspects of formation of restenoses after endothelial lesions].

The article deals with an analysis of the literature data concerning immunological mechanisms of the formation of restenoses after damage of the arterial wall, considering the participants of the early and late phases of inflammatory response initiated by endothelial damage. Also given is characteristics of the process of formation on the neointima, followed by description of the role of intercellular adhesion molecules in initiation and maintaining of the processes of acute and chronic inflammation.

[Peculiarities of treatment for pulmonary embolism (PE) in haematogenic thrombophilia].

The article deals with the results of examination and treatment of 70 patients presenting with acute pulmonary embolism (PE). The incidence of haematogenic thrombophilia in the examined patients amounted to 25.7%. The patients with haematogenic thrombophilia were found to have thromboses and embolisms in the cava filter more often than patients with unknown-aetiology pulmonary embolism. It was proved that differentiated therapy for haematogenic thrombophilia can significantly reduce the risk of recurrent thrombotic episodes in patients with acute pulmonary embolism.

[Changes of platelet aggregation in cancer patients].

Aggregation function of platelets was investigated in 119 patients with breast cancer, 17--gastric cancer and 11--cancer of large bowel. Levels of spontaneous and induced aggregation were abnormally high thus contributing to thrombophilic potential. Also, they were a factor of tumor progression and metastatic spread. Risk of thrombotic complication can be reduced and survival improved by administration of antiaggregants.

[A new method for determination of antithrombin III and its diagnostic significance]. / Novyi metod opredeleniia antitrombina III i ego diagnosticheskoe znachenie.

A new assay based on using an original chromogenic substrate (z-Ala-Ala-Arg-pNa) and designed for the determination of antithrombin III is described in the paper. It was used in examinations of patients with malignancy after surgery. The content of antithrombin III was detected to be lower in 12% of cases in 2 days after surgery. Additionally, patients with DIC, as complications after surgery, were examined to find out that the antithrombin III content was decreasing in them.