[GENDER DIFFERENCES OF THE HEMOSTASIS POSTAGRESSIVE EARLY RESPONSE IN ACUTE NECROTIZING PANCREATITIS].

The study was performed in a group of 25 patients with acute necrotizing pancreatitis (mean age 46.2 ± 6.74 years). Gender differences of the hemostasis postagressive early response in the early stages of the disease were identified by comparing the procoagulant , anticoagulant and fibrinolytic blood activity of men and women suffering from pancreatitis. Compared to men, women showed higher concentrations of fibrinogen, D-dimer and VWF and smaller values marked trombokrit , antithrombin III, inhibitor of plasmin and protein C (p < 0.05). These results suggest a greater tendency to thrombi formation in women with acute pancreatitis; We believe that gender differences should be the subject of further research.

[CORRECTION OF HEMOSTASIS WITH BLOOD PRODUCTS IN THE SURGICAL TREATMENT OF CONGENITAL HEART DISEASE IN INFANTS AND YOUNG CHILDREN].

The article deals with the safety and efficiency of recombinant activated factor VII (Coagil VII, Russia) and prothrombin complex concentrate (protromplex-600, Baxter Austria) in the neonatal and pediatric cardiac surgery. The study included 56 children aged from 7 days to 5.5 years underwent surgery with cardiopulmonary bypass for congenital heart defects repair. Clinical and laboratory evidences suggest that Coagil VII and protromplex-600 effective for bleeding stop. The drugs have no negative impact on hemodynamics. We did not identify allergic reactions and thrombosis associated with the introduction of drugs in the pen operative period.

[Express diagnostics of endotoxaemia during postoperative period in cardiac surgical patients].

Medical technologies development and recent approaches in management of patients with septic complications during the early postoperative period present new obstacles to the laboratory service. Endotoxin is a main agent in the systemic inflammatory cascade and plays important role in sepsis pathogenesis. Recent express methods of diagnostics allow determining blood activity of endotoxin during 30-50 min. 55 ICU patients with clinical and laboratory signs of systemic inflammatory response syndrome (SIRS) after cardiac surgery were studied in the single-center prospective research. Endotoxaemia was diagnosed by express tests. Level of endotoxaemia was assessed before and after sorption in 15 patients receiving complex intensive care with selective lipopolysaccharide (LPS) adsorption. Endotoxaemia level assessment allows to define indications for different programs of intensive care in time and to assess its efficiency. Test systems for assessment endotoxin level based on the principle of interaction antigen - antibody (EAA and MACH-endotox spp.) is a most efficient for express diagnostics of endotoxaemia.

[Diagnosis and correction of thrombohemorrhagic complications in cardiosurgical patients in the early postoperative period].

The methods of the prevention, diagnosis, and correction of hemostatic disorders are discussed in cardiosurgical patients. Prevention of hemorrhages requires hemostatic history data collection that allows identification of patients with concomitant hemophilia and those, taking antithrombotic drugs. The benefits of an extended study of blood coagulation disorders are shown in neonates and babies of the first year of life due to the physiological features of the hemostatic system and the pattern of heart disease. Algorithms are proposed for the diagnosis and treatment of hemorrhagic diathesis in the early postoperative period; a complex of minor signs of surgical hemorrhage is formulated, which makes it possible to timely perform rethoracotomy and to reduce blood transfusion. Efficiency evaluation and exclusion criteria for the use of recombinant factor VIIa are given. The efficiency of using the Russian drug tranexam versus epsilon-aminocapronic acid and aprotinin in the perioperative period was evaluated. The blood coagulative system was monitored in the treatment of disseminated intravascular coagulation in multiple organ dysfunction and sepsis, which promoted the timely use of recombinant human activated protein C and human antithrombin III. A diagnostic and treatment algorithm for replacement therapy of congenital heart disease concurrent with hemophilia A is given.

[Modified capillary blood prothrombin-time test for the calculation of an international normalized ratio].

Prothrombin time (PT) is usually measured in citrated venous blood. This test is undesirable in pediatric practice and in patients taking anticoagulants due to frequent venepunctures. Capillary blood PT test has no adverse impact. The authors have developed a standardized modified method for PT measurement in capillary blood. The adequacy of the test is due to the fact that analyzed test packed cell volumes are kept in mind. The modified test has shown that the values of normal plasma PT may be used to calculate an international normalized ratio (INR). It makes it possible to determine capillary blood PT in the range of packed cell volumes from 0.15 to 0.7 in the examinees and to monitor anticoagulant therapy. The results of the modified test closely correlated with those when determining PT and INR in venous plasma (r = 0.99) and applying the CoaguChek test (r = 0.97).

[Effect of the medicinal leech salivary gland secretion on the state of rat subcutaneous mast cells].

It is firstly showed that the medicinal leech salivary gland secretion (SGS) as a polycomponent system of proteins and low-molecular weight substances, activates rat subcutaneous mast cells in vitro prompting a decrease in the heparin saturation index and increasing some characteristic mast cells morphometric parameters. The same mast cell changes were detected by analysis of some specimens of subcutaneous cellular tissue in the point of skin injured by the leech bite. It is shown that these changes are saved during 3 days. The mechanical injury of rat skin does not effect the mast cells activation. Activation of mast cells by SGS is extended to the distant subcutaneous mast cells. It is expressed in sharp decreasing of heparin saturation index although not statistically positive. The secondary leeching on these distant points provokes reduction of mast cells activation and some decrease of post-leeching blood heparin content: 0.154 +/- 0.03 units/ml (n = 10) as compared with post-leeching blood heparin contents analysed from the wound after the primary leeching (0.160 +/- 0.03 units/ml, n = 10). Proceeding from these findings, participation of heparin secreted from activated mast cells in the support of post-leeching bleeding is suggested, the phenomenon which provides unloading of capillary pool by application of medicinal leeches for treatment many diseases.

[Use of domestic thromboplastins with attested international indices of sensitivity in the treatment of thrombophilia]. / Opyt primeneniia otechestvennykh tromboplastinov s attestovannym mezhdunarodnym indeksom chuvstvitel'nosti pri lechenii trombophilii.

Clinical evaluation of thromboplastins manufactured by RENAM (Moscow) with international index of sensitivity (IIS) 1.1-1.5 and comparison of the results with the data obtained in the same patients with foreign thromboplastins (Dade, USA; Behring, Germany; Diamed, Switzerland) and Mediolab thromboplastins (Russia) manufactured from different raw materials (rabbit brain and human placenta) showed that by sensitivity to indirect anticoagulants, Russian thromboplastins made by RENAM and Mediolab firms are not inferior to the best foreign analogs.

[Evaluation of the antithrombotic effect of plasma and thrombocyte apheresis in the complex therapy of patients with unstable stenocardia]. / Otsenka protivotromboticheskogo éffekta afereza plazmy i trombitsitov v kompleksnoi terapii bol'nykh s nestabil'noi stenokardiei.

Antithrombotic effect of plasmapheresis and thrombocytapheresis, used as part of combined treatment in 12 patients with unstable medication-resistant angina pectoris of functional class 4, was assessed by means of coagulation tests and resonance thrombography. The incorporation of three sessions of apheresis, removing 90% of plasma and 30% of platelet population, into the conventional treatment schedule is shown to have an anticoagulant, thrombolytic and platelet hypersensitivity-controlling effect. It is directly related to the volume of removed plasma and platelets, allows control of prethrombotic conditions and paves the way for an adequate response to subsequent medication.