[Some features of primary facial erysipelas under the present conditions].

AIM: To establish the features of clinical and laboratory changes in facial erysipelas in relation to its form. SUBJECTS AND METHODS: Twenty-three patients (15 women and 8 men) aged 31 to 78 years who were diagnosed with moderate facial erysipelas, primary facial erysipelas being present in 91% of cases were examined. The investigators studied the biochemical substrates and enzymes and composition of proteins in the serum by an electrophoretic method, the aggregation activity of red blood cells and platelets, plasma hemostasis (a coagulogram, levels of fibrinogen, antithrombin III, and D-dimer), and von Willebrand factor, a marker of vessel wall injury, on hospital admission at disease onset (days 1-3), over time (days 4-6, 7-9), and in convalescence (days 10-12), by obligatorily using control materials. CONCLUSION: Bleeding disorders in facial erysipelas correspond to the vasculite purpuric type of hemorrhagic diathesis (according to the classification developed by Z. S. Barkagan) with the laboratory signs of evolving disseminated intravascular coagulation: impairments in erythrocyte hemostasis and blood vessel endothelium. The changes in the functional properties of red blood cells match with the suppression of metabolic processes. And if the neuraminidase effect of ß-hemolytic streptococcus is shown at the level of the red blood cell membrane, the activity of NADase blocks processes in the entire macroenergetics. In the presence of a high fever reaction, the low levels of transaminases (aspartate aminotransferase, alanine aminotransferase) and membrane enzymes (alkaline phosphatase, creatinine phosphokinase) decrease the detoxification capacities of serum and increase a load on blood albumin and erythrocyte barriers. Rapid normalization of C-reactive protein levels enables one to use this simple and highly sensitive test to monitor the involution of erysipelatous inflammation and the efficiency of treatment. The changes in the hemostatic system and metabolic tests are less pronounced in patients with facial erysipelas than in those with lower-extremity erysipelas.

[Prehospital thrombolytic therapy with tenecteplase in patients with ST-elevation myocardial infarction].

We carried out prehospital thrombolytic therapy (TLT) with tenecteplase in 24 patients with ST-elevation myocardial infarction (MI) at the background of standard concomitant therapy with unfractionated heparin, aspirin, and clopidogrel and analyzed clinical course of MI, ECG dynamics, systolic left ventricular function according to echocardiography. In 20 patients coronary angiography was performed after TLT. Mean symptom - needle time was 113 min. In 14 patients (58%) TLT was carried out within 2 hours after appearance of symptoms. In 19 patients the course of disease was uncomplicated. Electrocardiographic criteria of effective reperfusion were registered in 14 patients (58%), angiographic criteria - in 13 patients (65% of subjected to angiography). Percutaneous intervention was performed in 18 patients (75%). Systolic left ventricular dysfunction was revealed in 5 patients (21%), aborted MI - in 4 patients. Significant correlation was found between aborted MI (r=0,38, p=0,034) and uncomplicated MI (r=0,40, p=0,027) and performance of TLT during first 2 hours. There were no hemorrhagic complications. Results of the study evidence for high efficacy of prehospital thrombolysis with tenecteplase and real possibility of its use under conditions of existing system of organization of urgent cardiological aid.

[Hemostatic disorders in severe forms of diphtheria and their correction with dicinon]. / Narusheniia gemostaza pri tiazhelykh formakh difterii i ikh korrektsiia ditsinonom.

The presence of thrombohemorrhagic syndrome (THS) has been established in 28 patients with toxic severe diphtheria of oropharynx. In view of the leading role of platelet affection in progression of hemorrhagic disorders in diphtheria, dicinon treatment may be beneficial. THS implications in unfavourable outcome of the disease and prognostic significance of critical thrombocytopenia are considered.

[Clinico-hemostatic characteristics of serum disease in toxic forms of diphtheria]. / Kliniko-gemosatziologicheskie osobennosti techeniia syvorotochnoi bolezni pri toksicheskikh formakh difterii.

Coagulative changes at the height of serum disease were investigated in 28 patients with severe diphtheria. It was found that on day 10 after first injection of diphtheria antitoxin hemocoagulation underwent activation with prevailing thrombogenesis coinciding in time with acute period of serum disease. The severity of serum complications correlated with the degree of coagulation activity. A relationship exists between the amount of the given antitoxin, duration of hormone therapy and occurrence of serum complications. There were specific for serum disease biochemical alterations indicative of destruction of blood cells and vascular-endothelial structures on the disease day 12-14.

[The dynamics of the liver and myocardial enzymes in different forms of diphtheria in adults]. / Dinamika pechenochnykh i miokardial'nykh fermentov pri razlichnykh formakh difterii u vzroslykh.

The authors studied changes in the levels of hepatic and myocardial enzymes in 89 patients with oropharyngeal diphtheria. The forms of the disease were different: carriage of the bacteria, local oropharyngeal diphtheria, toxic and subtoxic disease. Biochemical tests were also performed in 21 patients with lacunar angina. A correlation has been revealed between the intensity of fermentemia, its standing and the severity of the local lesions. Possible usage of biochemical markers is discussed for characterizing toxic diphtheria severity and prognosis of the disease.