[Lipid metabolism in patients with hematologic cancers]. / Lipidnyi obmen u bol'nykh onkogematologicheskimi zabolevaniiami.

It is considered that hypercholesterolemia is life-threatening and low cholesterol levels are a positive factor. However, taking into consideration the fact that cholesterol plays a key role in cell proliferation, it should be remembered that its low blood level may be linked to high cholesterol demands from neoplastic cells. The literature review analyzes the results of recent investigations of lipid metabolism in patients with hematologic cancers and their other types. All given investigations show a significant reduction in the serum levels of total cholesterol and high-density lipoproteins in patients with hematological disease at its onset. The data for other indicators of the lipid transport system are ambiguous. Such changes have been elucidated to be associated with the accumulation of cholesterol in the leukemia cells due to enhanced synthesis de novo, a more active absorption from circulation and blocked release of its surplus. If the disease runs a favorable course, lipid metabolic parameters become normalized and, in case of remission, correspond to those seen in healthy individuals. They continue to decline in patients with disease progression. This allows the consideration of cholesterol, its fractions, and apolipoproteins as biochemical prognostic markers in hematological cancer patients and as indicators for assessment of treatment results. In addition, there is evidence for the effect of chemotherapeutic agents on lipid metabolism. Recent attempts to elaborate new treatment strategies, by using the current knowledge on the role of lipid metabolism in cancers, are considered.

[The condition of lipid metabolism in patients with newly diagnosed acute leukemia.]

The article presents comparative analysis of lipid metabolism in patients with acute leukemia depending on form of disease, age, occurrence of cardiovascular pathology and infectious complications. The study sampling included 148 patients with primarily diagnosed acute leukemia aged from 16 to 79 years (average age is 54 years). The control group consisted of 28 healthy volunteers aged from 26 to 75 years (average age is 49 years). The distribution by age in this group corresponded to distribution in group of patients (p>0.05, khi-square). It is established that under acute promyelocyte leukemia indicators of lipid metabolism are subjected to minimum alterations because only concentration of high density lipoproteins reliably decreased. In case of other forms of acute myeloid leukemia and acute lymphoblastic leukemia significant alterations of lipid specter of blood occur characterized by decreasing of content of cholesterol, high and low density lipoproteins and apolipoprotein A1.Also it was established that these alterations have no dependence on age of patients in contrast with healthy individuals having direct dependence of level of cholesterol and high and low density lipoproteins on age. The occurrence of concomitant cardiovascular pathology in patients with acute leukemia had no effect on indicators of lipid metabolism. The occurrence of infectious complications during period of manifestation of acute leukemia enhances shifts in indicators of lipid transport system in direction of decreasing of levels of cholesterol and high and low density lipoproteins.

[The dynamics of biochemical blood indicators in patients with hemophilia and posttransfusion hepatitis receiving hepatotropic therapy].

The sample of 128 patients with hemophilia aged from 1 to 71 years (Me 32) was examined. The study established that 109 patients (85.2%) had hemophilia A and 19 patients (14.8%) had hemophilia B. In 77 adult patients (60%) markers of viruses of hepatitis C and B were detected and the signs of disorders of liver functions were established in 64% out of them. These signs included reliable increasing of levels of AST and ALT, total and conjugated bilirubin, urea and creatinine and absence of any clinical manifestations. The detected alterations served as a background for implementation of hepatotropic therapy with pharmaceutical Heptral. The ademetionin is the reactant of preparation. After two weeks of intravenous application of Heptal the tendency to normalization of content of bilirubin was established. The significant decrease of activity of aminotransferases was detected, nevertheless their levels still overridden physiological standard. This situation required to prescribe pharmaceutical and to continue treatment in out-patient conditions. The continuous repair of functional activity of hepatic cells requires further search of more effective schemes of therapy.

[The evaluation of sensitivity and specificity of technique of detection of C-reactive protein under diagnostic of infectious complications in patients with acute lymphoblastic leucosis receiving chemotherapy].

The C-reactive protein is a generally recognized marker of inflammation and bacterial infection. However, issue of diagnostic effectiveness of this indicator is still open-ended in case of patients with oncologic hematological diseases. The level of C-reactive protein can increase under neoplastic processes. On the contrary, the inhibition of immune response observed under cytoplastic therapy can decrease synthesis of this protein. The study was organized to establish levels of C-reactive protein as markers of infection in adult patients with acute lymphoblastic leucosis under application of chemotherapy and to evaluate their diagnostic effectiveness. The sampling included 34 patients with acute lymphoblastic leucosis all patients had infectious complications at various stages of treatment. The levels of C-reactive protein in groups of patients with localized infections (mucositis, abscess, pneumonia, etc.) or fever of unknown genesis had no statistical differences but were reliably higher in patients without infectious complications. The concentrations of C-reactive protein in patients with syndrome of systemic inflammatory response and sepsis had no differences. At the same time, level of C-reactive protein under systemic infection (syndrome of systemic inflammatory response, sepsis) was reliably higher than in case of localized infection. The diagnostically reliable levels of C-reactive protein were established as follows: lower than 11 mg/l--infectious complications are lacking; higher than 11 mg/l--availability of infectious process; higher than 82 mg/l--generalization of infection. The given levels are characterized by high diagnostic sensitivity (92% and 97% correspondingly) and specificity (97% and 97%) when patients receive therapy without application of L-asparaginase. At the stages of introduction of this preparation effecting protein synthesizing function of liver sensitivity of proposed criteria are decreased (69% and 55% correspondingly). However; due to high specificity (100% and 96%) their diagnostic effectiveness remains high.

[The indicators of hemostasis and functions of liver in patients with acute lymphoblastic leucosis under manifestation of disease and induction therapy].

The function of liver and synthesized by it components of blood coagulation were studied on sampling of 25 patients with acute lymphoblastic leucosis in the debut of disease and under implementation of induction of remission. Before treatment the hepatotoxicity was detected in 40% of patients. The reliable correlation between level of aspartataminotransferase and number of leucocytes and blasts (rs = 0.401 and rs = 0.406 correspondingly) testifies the role of leucosis cells in functional disorders of liver during this period of disease. Against the background of cytostatic therapy the signs of liver damage were presented in 76% of patients. The maximum expressed hepatotoxicity was observed at 9-14 day of treatment. The decrease of components of hemostasis synthesized in liver was observed at 16-21 day of treatment. During this time the synthesis of factors of thrombin complex, antithrombin III and plasminogen was disordered. The plasminogen also decreased at the expense of its consumption as a result of fibrinolysis activation validated by decreased level of D-dimers. It is proved that in the debut and under treatment acute lymphoblastic leucosis the danger of development of thrombotic hemorrhagic complications is related both with derangement of synthesis of procoagulants, antithrombin III and plasminogen and with their consumption in case of activation of intravascular coagulation with leucosis process and cytostatic.

[C-reactive protein as a marker of the severity of an infectious process in acute myeloid leukemia patients with neutropenia].

AIM: To determine C-reactive protein (CRP) levels as diagnostic markers of infection in acute myeloid leukemia (AML) patients with neutropenia. SUBJECTS AND METHODS: Sixty-three AML patients (28 men and 35 women) aged 20 to 77 years (median 50 years) were examined. According to the French-American-British (FAB) classification, the types of AML were as follows: M0 (n = 3), M1 (n = 9), M2 (n = 35), M4 (n = 10), and M5 (n = 6). All the patients had chemotherapy-associated neutropenia (granulocytes, less than 0.5.10(9)/l). In different treatment steps, all the patients developed infectious complications (the study analyzed the data of 86 cases). RESULTS: In patients with localized infections (such as mucositis, abscess, pneumonia, etc.) or fever of unknown origin (FUO), the levels of CRP were not statistically significant different, but were significantly higher than in those without infectious complications. The concentrations of CRP did not differ in patients with systemic inflammatory response syndrome (SIRS) and in those with sepsis. At the same time, the level of CRP in systemic infection (SIRS, sepsis) was significantly higher than that in localized infection (p < 0.001). In patients with neutropenia, the median CRP levels were as follows: 7 mg/l (range 0-37; 95% reference interval (RI) 0 to 32) for those without infection 56 mg/l (range 13-104; 95% RI 17 to 104) for those with localized infection or FUO; and 168 mg/l (range 103-399; 95% RI 105 to 362) for those with systemic infection. CONCLUSION: CRP is a marker of the severity of an infectious process in AML patients with neutropenia. The increase of its level more than 32 mg/l serves a valid criterion for the presence of infection and more than 105 mg/l does for that of a systemic inflammatory response in these patients.

[The prognostic indicators of development of ATRA-syndrome under treatment of acute promyelocyte leucosis].

The application of all-trans-retinoic acid (ATRA) in the protocols of treatment of acute promyelocyte leucosis provided the achievement of 95% of full remissions and fast correction of coagulopathy. Besides, ATRA along with positive impact can exert the side effects, among which the most dangerous is the differentiation syndrome. On the basis of analysis of clinical signs, biochemical, hemostasiologic and morphologic blood indicators it is established that among prognostic criteria of differentiation syndrome development are presence of febrile temperature, decrease of content of thrombocytes lesser than 20-109/l (deep degree of thrombocytopenia), prolongation of index of activated partial thromboplastin time relative to norm before treatment start. Apart from this, the following factors also are among such kind of criteria: decrease of hemoglobin after ATRA prescription before differentiation syndrome development, on-going hypofibrinogenemia and deep degree of thrombocytopenia under concurrent increase of content of urea and creatinine as compared with initial values in treatment dynamics.

[The condition of endothelium and hemostasis in patients with primary diagnosed acute lymphoblast leucosis].

The evaluation of state of endothelium and plasma hemostasis, thrombocytopenia degree, rate of thrombo-hemorrhagic complications in adult patients with acute lymphoblastic leucosis in the period of disease manifestation was made. The thrombosis developed in 1 out of 24 (4.2%) examined patients, hemorrhagic syndrome in 11 out of 24 (45.8%) examined patients. The last case is closely linked with severity of thrombocytopenia occurred in patients with number of thrombocytes less than 50 x 109/l. At the same time, high correlation between number of leukemic cells and level of B-dimers (rs = 0.703) testifies that the leucosis process activates intravascular thrombus formation. The higher content of B-dimers in 100% of patients validates this assumption. The high levels of soluble thrombo-modulin and von Willebrand factor indicate the loss of thromboresistance by vessel endothelium and the activation of prothrombin mechanisms. The statistically valid coefficients of correlation between concentrations of thrombomodulin and D-dimers (rs = 0.598) and the level of von Willebrand factor and severity of hemorrhagic syndrome prove that disorders of blood coagulation under acute lymphoblast leucosis occur with active involvement of endothelium.

[State of the endothelium and hemostasis in acute leukemia].

The review presents modern conceptions of disturbances in endothelial lining of the vessels and plasmic hemostasis in patients with acute leukemia; different mechanisms of coagulation disorders in acute leukemia: effects of leukemic cells containing procoagulants, fibrinolytic and antifibrinolytic substances, of intensive chemotherapy and inflammation. All these impacts impair endothelial cells and trigger plasmic coagulation cascade; the initiator of coagulation is a tissue factor. Mechanisms of this process and statistics of thrombohemorrhagic complications in different variants of acute leukemia are outlined.

[Determination of the Willebrandt factor antigen by immunoenzyme technique].

The purpose of the study was to determine the normal values of Willebrandt factor antigen (WF:Ag) in accordance with AB0 blood group affiliation and to compare the results of its determination when two test systems were used. Ninety-four plasma samples from healthy individuals aged 18 to 62 years (median 38) were tested. The test systems manufactured by Technoclone and Axis-Shield were employed. In the samples from blood group 0 subjects, the level of WF:Ag was significantly lower than that in those from blood group A, B, and AB subjects (p < 0.05). There were no significant differences in the determination results between blood groups A, B, and AB subjects (p > 0.05). Great discrepancies were found in the results of some tests when WF:Ag was determined using various test systems. This is accountable to different specificity of the anti-WF antibodies obtained by various manufacturers. Nevertheless, the revealed differences, the lower normal ranges calculated from the results obtained using these test systems agree and no great differences were found between the samples (p > 0.05). Therefore, both test systems have the equal value in the diagnosis of Willebrandt disease.

[Orbital phlegmon: clinical picture, diagnosis].

The purpose of the study was to enhance the efficiency of early diagnosis of orbital phlegmon, by examining its clinical picture and using instrumental studies. Sixty-three patients with orbital phlegmon were treated at hospital in 1985 to 2007. Its diagnosis employed ultrasound and X-ray studies. Orbital phlegmon was diagnosed in 30 patients with orbital injury and 33 patients with inflammatory diseases of the eyelids, face, nasal sinuses, and infection metastasis from septic foci. The disease was characterized by intoxication syndrome, eyelid inflammatory changes, chemosis, exophthalmos, and ophthalmoplegia. The following complications: neuritis, optic nerve ischemia, meningoencephalitis, brain abscess, cavernous sinus thrombosis, and sepsis were observed. Ultrasound and X-ray (computed tomography, magnetic resonance imaging) studies provide the diagnosis of the disease in early periods and timely medical and surgical treatments.

[Obtaining active extracts for use in production of soluble thromboplastin]. / Poluchenie aktivnykh ékstraktov dlia prigotovleniia tromboplastina rastvorimogo.

Methods of obtaining (from cadaveric human brain) the highly-active extracts to be used later as raw-materials for thromboplastin manufacturing, which is applied to determine the prothrombin (thromboplastin) time of human plasma or blood, are described in the paper. The study resulted in defining the optimal requirements to choosing the raw-materials, storing regime, centrifuging and extraction. The thus elaborated technology of soluble thromboplastin manufacturing ensures the production of a reagent with a high sensitivity to a changing level of factors VII and X and to a reducing activity of the prothrombin complex, which is achieved through the impact of indirect anticoagulants.

[Immunologic peculiarities of uveitis concurrent with systemic pathologies]. / Immunologicheskie osobennosti uveitov pri sistemnykh zabolevaniiakh.

Immunologic examinations were performed in 111 patients with uveitis concurrent with a variety of systemic pathologies, including 85 males and 26 females, mean age--32.4 +/- 5.8. A higher IL-6 content in blood serum (BS) and in lachrymal fluid (LF) was detected in all patients. The IL-4 content was lower in uveitis associated with ankylosing spondylitis and with Reuter's disease, whereas, it was higher in juvenile rheumatoid arthritis. The systemic immunity changes were related with the hemostasis impairments in the phagocytic, humoral and cellular chains: an enhanced functional activity of phagocyte cells, a lower absolute quantity of T-lymphocytes, a higher count of B-cells, a reduced concentration of IgM and of circulating immune complexes (CIC), and a diminished general hemolytic activity of the complement in BS. A reduced concentration of the secretory fraction of IgA, IgG and IgM concurrent with higher concentrations of IgA, C3- and C4 complement components, CIC and of lysozyme activity in LF was detected in the local immunity system.

[Proinflammatory cytokines in the development of bacterial keratitis]. / Rol' povospalitel'nykh tsitokinov v razvitii bakterial'nykh keratitov.

The production of proinflammatory cytokines IL-1alpha, IL1 2b, TNF-alpha and IL8 in lachrymal fluid was dynamically determined in 134 patients with uncomplicated and complicated clinical courses of primary (at exacerbation of the cornea) and secondary (with dystrophic changes in the cornea) keratitis. The level of proinflammatory cytokines in lachrymal fluid was found to essentially affect the clinical course in different types of keratitis.

[Follow-up results of surgical correction of ocular ischemic syndrome]. / Otdalennye rezul'taty khirugicheskoi korrektsii glaznogo ishemicheskogo sindroma.

The influence of surgeries in the carotid arteries produced on the visual functions and ocular blood circulation was studied in patients with ocular ischemic syndrome (OIS) during the remote postoperative period. A total of 180 patients with OIS (including 104 patients with an acute OIS clinical course and 76 patients with primary chronic clinical course) and with a pronounced stenosis of the carotid arteries were examined preoperatively and postoperatively within 1 or 2 years. A reliably improved visual acuity (preoperatively -0.37 +/- 0.05; and postoperatively -0.52 +/- 0.07; p < 0.01), positive dynamics in the electric sensitivity threshold and in a lability of the optic nerve were observed in patients with the acute OIS clinical course after reconstructive surgeries in the carotid arteries. An increase in contrast sensitivity of the visual analyzer was detected in 28.8% of patients with the acute clinical course and in 10.5% of patients with the chronic OIS clinical course. An improved blood circulation through the ocular artery was stated in patients of both groups. Reconstructive surgeries in the carotid arteries are most effective in correcting the acute OIS clinical variation.

[Certain aspects of the etiology of normal-pressure glaucoma]. / Nekotorye aspekty patogeneza glaukomy normal'nogo davleniia.

Two groups of clinical-and-pathogenetic patients were defined through examining the hydrodynamics and hemodynamics of the eye in 67 patients (110 eyes) with normal pressure glaucoma (NPG); the below examinations methods were made use of: three-hour and one-day tonometry, tonography, determination of tolerance of the intraocular pressure (IOP), ultrasonic Doppler-graphy of the ocular artery and fluorescent angiography of the optic nerve. Tolerance of the original IOP, which was close to the age norm according to tonography readings, a reduced linear blood circulation, somewhat higher parameters of the peripheral resistance registered in the ocular artery (OA) and in the central retinal artery--(CRA)--(p < 0.05) and absolute defects of blood filling of the vascular system of the optic nerve disk (OND) were found to be typical of the group with a resistant and relatively low pressure (< or = 20 mm Hg), which was indicative of the predominant role of vascular disorders in the discussed patients. As for the group with a relatively high pressure (< or = 26 mm Hg), apart from the impaired orbital blood circulation, intolerance of the original IOP, as well as reduced parameters of secretion and discharge were found to be typical of it. The study data prove that NPG is characterized by polymorphism and polyetiologic nature.

[Glaucomatous neuropathy concomitant with carotid pathology: the specificity of pathogenesis and diagnostics]. / Glaukomatoznaia neiropatiia v sochetanii s patologiei sonnykh arterii: osobennosti patogeneza i diagnostiki.

The below clinical peculiarities of glaucomatous optic neuropathy (GON) were defined in carotid lesions: saucer-shaped excavation of the optic nerve disk, local or total loss of the retinal ring, peripapillary chorioretinal atrophy as well as central defects and segmental prolapses in the visual field. Fluorescence angiography was used to determine the regions of local disk ischemia. Ultrasound scanning of eye vessels provide for detecting the impaired blood circulation in the ocular artery and in the central retinal artery, i.e. a pronounced lower terminal diastolic velocity of blood flow and a higher resistance index.

[Triplex scanning of orbital vessels in patients with normal pressure glaucoma]. / Tripleksnoe skanirovanie orbital'nykh sosudov u bol'nykh glaukomoi normal'nogo davleniia.

Bloodflow in the orbital artery and central retinal artery was studied by triplex scanning in 35 patients with normal pressure glaucoma, and 14 subjects without signs of glaucoma. Significant differences in the studied parameters were detected in the patients in comparison with the controls: decreased linear bloodflow velocity in the orbital (p < 0.01) and central retinal arteries (p < 0.01), increased peripheral resistance indexes in both arteries (p < 0.05) in patients with normal pressure glaucoma, and decreased bloodflow velocity in the central retinal artery in primary open-angle glaucoma (p < 0.05). The time course of hemodynamic parameters was different in normal pressure and primary open-angle glaucoma. These data confirm the important role of vascular disorders in the pathogenesis of normal pressure glaucoma.

[Status of the cardiovascular system in patients with normal pressure glaucoma]. / Sostoianie serdechno-sosudistoi sistemy u bol'nykh glaukomoi s normal'nym davleniem.

Twenty patients with normal pressure glaucoma (NPD) were examined. Concomitant cardiovascular diseases were diagnosed in 19 (95%) of them. Echocardioscopy with color mapping showed various diseases with left-ventricular dysfunction in 8 examinees. Dopplerography of orbital vessels showed a significant decrease of bloodflow velocity in the orbital artery and increased peripheral resistance indexes in the orbital and central retinal arteries in 20 NPD patients in comparison with healthy controls (p < 0.05, p < 0.01). Atherosclerotic involvement of the internal carotid artery was detected in 15 of 20 patients, in 4 of these with hemodynamically significant sclerosis of more than 50%. The contribution of cardiovascular disease to decrease of orbital bloodflow is discussed.