Time-dependent changes in extra-domain A-fibronectin concentration and relative amounts of fibronectin-fibrin complexes in plasma of patients with peripheral arterial disease after endovascular revascularisation.

Fibronectin (FN) may be involved in time- and stage-dependent and inter-related controlled processes of inflammation, coagulation, and wound healing accompanying peripheral arterial disease (PAD). In the present study, FN and FN-containing extra-domain A (EDA-FN), macromolecular FN-fibrin complexes, and FN monomer were analysed in the plasma of 142 PAD patients, including 37 patients with restenosis, for 37 months after revascularisation. FN concentration increased significantly in the plasma of PAD patients within 7 to 12 months after revascularisation, whereas the high concentration of EDA-FN was maintained up to 24 months, significantly higher in the group 7 to 12 months after revascularisation with recurrence of stenosis and lower in the PAD groups 1 to 3 months and 4 to 6 months after revascularisation with comorbid diabetes and ulceration, respectively. The relative amounts of FN-fibrin complexes up to 1600 kDa and FN monomer were significantly higher, within intervals of 4 to 24 months and 4 to 6 months after revascularisation, respectively. Moreover, the relative amounts of 750 to 1600 kDa FN-fibrin complexes within 13 to 24 months after revascularisation were higher in comparison with those in the group without restenosis. In conclusion, high levels of EDA-FN and FN-fibrin complexes could have potential diagnostic value in the management of PAD patients after revascularisation, predicting restenosis risk.

Plasma concentrations of tissue factor and its inhibitor in chronic thromboembolic pulmonary hypertension: a step closer to explanation of the disease aetiology?

BACKGROUND: The aetiology of chronic thromboembolic pulmonary hypertension (CTEPH) is not clearly understood. In some patients, the disease is preceded by acute pulmonary embolism (APE), and is characterised by intravascular thrombosis, vasoconstriction, inflammation and remodelling of pulmonary arteries. Ensuing pulmonary hypertension leads to potentially fatal chronic right ventricle failure. Both inborn and acquired risk factors were identified. Pathogenesis of haemostatic disorders is not completely explained, and extrinsic coagulation pathway disorders may play a role in CTEPH aetiology. AIM: To evaluate levels of tissue factor (TF) and tissue factor pathway inhibitor (TFPI) in CETPH, and to delineate their role in the disease pathogenesis. METHODS: Plasma concentrations of TF and TFPI were evaluated in 21 CTEPH patients, in 12 patients with pulmonary arterial hypertension (PAH), in 55 APE survivors without persistent pulmonary hypertension after at least 6 months from the acute episode, and in 53 healthy volunteers (control group C). Most patients were treated with vitamin K antagonists (VKA), and some with unfractionated or low molecular weight heparin. Exclusion criteria included malignancy, inflammation, and recent operation. RESULTS: Tissue factor concentration was lower in CTEPH and in post-APE patients, not stratified by anticoagulation modality, as compared to control group (p = 0.042; p = 0.011) and PAH group (p = 0.024, p = 0.014). Patients with CTEPH and post-APE on adequate VKA-anticoagulation had similar TF concentration to group C. TFPI concentration was similar in CETPH and post-APE patients irrespective of anticoagulation, and higher as compared to group C (respectively, p = 0.012; p = 0.024; p = 0.004). TFPI concentration was similar in patients with CETPH and in post-APE group, both on adequate VKA-anticoagulation when compared to group C. In the post-APE group, there was no significant difference in TFPI concentration between patients receiving adequate and subjects without anticoagulation. Group C was significantly (p = 0.000) younger than any other group, and showed correlation (r = 0.31) between age and TFPI concentration. CONCLUSIONS: In CTEPH there is a high consumption of TF, leading to reduction in plasma concentration of TF and increase in TFPI. Adequate VKA-anticoagulation normalises TF and TFPI plasma concentrations, as is the case of APE survivors.

[Selected endothelial hemostatic markers in patients with peripheral arterial disease after endovascular revascularization and restenosis formation]. / Wybrane sródblonkowe markery hemostazy u pacjentów z miazdzyca tetnic konczyn dolnych po wewnatrznaczyniowej rewaskularyzacji i po powstaniu restenoz.

Surgical and endovascular revascularization of ischemic legs in patients with peripheral arterial disease (PAD) can damage the arterial wall (endothelial and smooth muscle cells). Hemostatic factors released during endothelial dysfunction can lead to restenosis. 1. Determination of selected endothelial hemostatic factors in PAD patients and a reference group. 2. Prospective observation of new restenosis appearance in PAD patients after endovascular revascularization. 3. Comparison of selected endothelial hemostatic factors between non-restenotic and restenotic PAD patients. 150 PAD patients after endovascular revascularization - 90 men and 60 women, aged 44-88 (mean 65.5) years - were examined. During one-year observation after the revascularization procedures in 38 PAD patients restenosis occurred, when blood samples were also collected. The reference group consisted of 53 healthy persons - 44 men and 9 women, aged 20-56 years. Blood was drawn in the morning into 3.2% sodium citrate at a ratio of 9:1. Tissue factor (TF), tissue factor pathway inhibitor (TFPI), thrombomodulin (TM), von Willebrand factor (vWF) and tissue plasminogen activator (t-PA) were measured in plasma with commercial tests using the enzyme immunoassay. In the plasma of PAD patients after revascularization, the concentrations of TF and vWF were significantly higher, TM lower, TFPI and t-PA similar compared to the reference group. Six months after revascularization the level of TF had increased and vWF had significantly decreased. The endothelial hemostatic factors before and after restenosis did not significantly differ except TF, which after restenosis was higher. Increased TF and vWF levels in PAD patients indicate arterial endothelial cell damage, by atherosclerotic and revascularization processes. In PAD patients with restenosis compared to these patients before restenosis the determined endothelial hemostatic factors, except TF level, did not significantly differ. Perhaps TF participates in restenosis formation.

Tissue factor and other hemostatic parameters in patients with advanced peripheral artery disease after endovascular revascularization - search for hemostatic factors which indicate restenosis.

BACKGROUND: In patients with peripheral artery disease (PAD) a hypercoagulable state and thromboembolic complications occur. Revascularization procedures increase this state, sometimes leading to restenosis. Restenosis following balloon angioplasty (PTA)and stent implantation is ≥ 50% of artery stenosis. OBJECTIVES: To determine the concentration of tissue factor (TF), tissue factor pathway inhibitor (TFPI), thrombin-antithrombin (TAT) complexes, fibrinogen and D-dimers in the blood of patients with PAD after peripheral endovascular revascularization of the lower legs and in PAD patients with restenosis. MATERIAL AND METHODS: The study included 150 patients with PAD, 90 men and 60 women, aged 44-88 (mean 65.5) years, after successful peripheral angioplasty (PTA) and/or with stenting. During the 6 months after the revascularization procedures, restenosis occurred in 27 patients. The reference group consisted of 53 healthy persons (44 men and 9 women, aged 20-56 years). Blood was drawn in the morning into 3.2% natrium citrate at a ratio of 9 : 1. The concentration of TF, TFPI, TAT complexes and D-dimers were measured in plasma with commercial tests using an enzyme immunoassay. Fibrinogen was determined with coagulometer. RESULTS: In the plasma of patients with PAD after endovascular revascularization, the concentrations of TF, TAT complexes, fibrinogen and D-dimers were significantly higher compared to the reference group. During the six months of observation, 27 patients developed restenosis. The results of hemostatic factors in patients with restenosis were compared with the same patients before restenosis and the group of 123 PAD patients after endovascular revascularization. TF and fibrinogen levels in the 27 patients with restenosis were significantly higher than in the group of PAD patients before restenosis. CONCLUSIONS: Statistically significantly higher levels of tissue factor (TF) and fibrinogen in PAD patients with new restenosis, compared to those without restenosis after endovascular revascularization, indicate they can participate in the formation of restenosis.

Selected clotting factors in blood of patients with abdominal aortic aneurysms.

BACKGROUND: Tissue factor (TF), tissue factor pathway inhibitor (TFPI) and vascular endothelial growth factor A (VEGF-A) present in vascular structures take part in blood coagulation and in organ revascularisation. The concentration of thrombin-antithrombin complexes (TAT) in blood of patients with abdominal aortic aneurysms (AAA) reflects thrombin-generation. AIM: To determine the concentration of TF, TFPI, VEGF-A and TAT complexes in blood of patients with AAA and to consider if these factors after clot formation can play a role in the pathogenesis of abdominal aortic aneurysms. METHODS: Forty eight patients (43 men and 5 women) in the age of 59-80 (mean 72) years with AAA were examined. The blood was drawn in the morning to 3.2% natrium citrate in proportion 9:1. The concentration of TF, TFPI, VEGF-A and TAT complexes were measured in plasma with commercial kits using enzyme immunoassay. RESULTS: In plasma of patients with AAA the mean concentration of TF was elevated almost twice and TAT complexes were three times higher compared with controls. But the mean levels of TFPI and VEGF-A were similar as in control group. CONCLUSIONS: Increased concentrations of TF and TAT complexes indicate on high thrombin-generation, hypercoagulability and formation in abdominal aortic aneurysm of intraluminal thrombus, which can induce proteolytic processes in aortic wall.

[Endothelial dysfunction in peritoneal dialysis patients and its relationship to nutrition]. / Zaburzenia funkcji sródblonka u chorych dializowanych otrzewnowo i ich zwiazek ze stanem odkywienia.

Endothelial dysfunction (ED) in peritoneal dialysis patients plays pivotal role in progression of atherosclerosis and hemostasis disturbances. Malnutrition is one of the most important complication of PD. Both ED and malnutrition cause higher rate of cardiovascular events in these patients. 32 PD patients were analyzed. Endothelial function was assessed by measurements of serum level of vWF:Ag; t-Pa:Ag; TM:Ag. Nutritional status assessment included: body mass index-BMI, MAMC measurements; and serum albumin, total protein, prealbumin, transferrin, cholesterol, insulin, insulin like growth factor-1 (IGF-1). There were higher levels of vWF:Ag but lower of t-PA:Ag and TM:Ag after 12 month of observation. Serum levels of prealbumin, insulin, cholesterol were stable, but there were lower levels of albumin, IGF-1, and higher of transferrin at the end of the follow up. There were no differences in anthropometric indices during the follow up. We found statistically significant linear correlations: t-Pa:Ag vs prealbumin; t-Pa:Ag vs cholesterol; TM:Ag vs albumin. In the course of 12 months observation of peritoneal dialysis patients we found deterioration of endothelial function, expressed by evaluated endothelial antigens. Some correlations found in our study might express close relationship between endothelial function markers and nutritional status.

[Von Willebrand factor and thrombomodulin as markers of endothelial cell functions in children with chronic viral hepatitis]. / Czynnik von Willebranda i trombomodulina jako wskazniki czynnosci sródblonka naczyn u dzieci chorych na przewlekle wirusowe zapalenie watroby.

INTRODUCTION: Vascular endothelial cells play an important role in haemostasis. Similar to hepatocytes they synthesise many substances taking part in blood clotting and fibrinolysis. OBJECTIVE: The aim of the study was the evaluation of markers of endothelial cells: von Willebrand factor (vWf) and thrombomodulin (TM) in children with chronic viral hepatitis. MATERIAL AND METHODS: VWf and TM levels were measured using ELISA method. The examined group consists of 105 children with chronic viral hepatitis aged 2 to 18 years. RESULTS: The concentrations of vWf and TM were significantly higher in chronic viral hepatitis compared to controls. The values of TM were higher in chronic viral hepatitis B in comparison to hepatitis C and higher in boys than in girls. The markers of endothelial cells do not depend on the degree of inflammation and fibrosis. CONCLUSION: Increased levels of vWf and TM suggest stimulation of endothelial cells in children with chronic viral hepatitis B and C.

[Fibrinolysis parameters: plasmin-alpha2 antiplasmin complexes (PAP) and D-dimers in acute coronary syndromes without ST segment elevation]. / Parametry ukladu fibrynolizy: kompleksy plazmina-alpha2 antyplazmina oraz d-dimery w ostrych zespolach wiencowych bez uniesienia odcinka ST.

The aim of the paper was to determine concentrations of plasmin-alpha2 antiplasmin complexes (PAP) and D-dimers in blood of patients suffering from acute coronary syndromes without ST segment elevation. 78 patients, including 37 females and 41 males, aged 41-79 years (mean age 63.2) were included in the study. Concentrations of PAP were determined by immmunoenzymatic method using Enzygnost PAP micro kit and concentrations of D-dimers using Dade Berling Enzygnost D-Dimer micro kit. Statistically significant, higher concentrations of PAP and D-dimers, indicating increased fibrinolytic activity of blood, were observed in patients with acute coronary syndrome than in the control group. Significantly higher concentrations of D-dimers were found in the group of patients above the age of 50, when compared with younger patients. Lower D-dimers levels were observed in smokers. Gender, coexisting hypercholesterolaemia, arterial hypertension and diabetes had no impact on concentrations of PAP and D-dimers in blood of patients suffering from acute coronary syndrome without ST segment elevation.

[Endothelial parameters in blood plasma of patients suffering from ischaemic heart disease and undergoing surgery with extracorporeal circulation]. / Wskazniki sródblonkowe w osoczu chorych na chorobe wienicowa operowanych w krazeniu pozaustrojowym.

INTRODUCTION: The participation of disturbances of the vascular endothelial function in the pathogenesis of post perfusion syndrome is controversial. AIM: The aim of the study was the evaluation of the parameters of vascular endothelial injury in the blood plasma of patients undergoing surgery with extracorporeal circulation. METHODS: The study was performed in the group of 32 patients (M/F 23/9) with ischaemic heart disease, undergoing coronary artery bypass with extracorporeal circulation. In the blood plasma obtained in the couple of time points in the perioperative period the determinations were done as followed: the concentrations of von Willebrand factor antigen (vWf Ag), tissue plasminogen activator antigen (t-PA Ag), antigen of plasminogen activator inhibitor type 1 (PAI-1 Ag) and fibrinogen. The control group consisted of 29 healthy volunteers sex and age matched. RESULTS: In blood of patients suffering from ischaemic heart disease before surgery the increased concentrations of vWF Ag, t-PA Ag and fibrinogen were observed. The concentrations of t-PA Ag and vWf Ag hesitated in the perioperative period but always were significantly higher than observed in the control group. CONCLUSIONS: (1) In the blood of patients suffering from the ischemic heart disease undergoing bypass surgery with an extracorporeal circulation the increased concentrations of t-PA Ag and vWf Ag were observed what is the evidence of stimulation/ damage of the vascular endothelium. (2) High levels of t-PA and vWf is seemed to be connected with injury of vessels during coronary artery bypass.

[Activation of fibrynolysis in children with chronic B or C hepatitis]. / Aktywacja ukladu fibrynolizy u dzieci chorych na przewlekle wirusowe zapalenie watroby typu B lub typu C.

UNLABELLED: Fibrinolysis is involved in numerous systemic processes, including inflammation and tissue remodeling. Up to date researchers focused on hemostasis problems in patients with cirrhosis. There are little data about fibrynolysis in patient with chronic viral hepatitis. The aim of the study was to evaluate selected fibrinolytic parameters in children with chronic B or C hepatitis. MATERIAL AND METHODS: 98 children aged 4 to 17 years (27F, 71M) with histopatologically confirmed chronic B or C hepatitis were included in the study. The control group consisted of 51 children median aged 12.5 years (25F, 26M) on strict gluten-free diet at least 5 years because of coeliac disease. In platelet-poor plasma obtained from all children selected fibrinolytic parameters were determined: fibrinogen level (Hemolab Fibrinomat bioMerieux S.A.), plasminogen activity (Berichrom-Plasminogen Behring), tissue plasminogen activator antigen level (t-PA) (Imulyse t-PA Biopool), plasminogen activator inhibitor 1 level (PAI-1) (Imulyse PAI-1 Biopool), plasmin-alpha2-antiplasmin complex level (PAP) (Enzygnost PAP micro) oraz D-dimer level (Vidas D-Dimer bioMérieux S.A.). RESULTS: In children with chronic viral hepatitis statistically significant lower fibrinogen level (p<0.03) and PAI-1 level (p<0.0001) and higher t-PA level (p<0.0001) in comparison to control group were found. In children with chronic B hepatitis significant lower PAI-1 level (p<0.0001) and higher PAP level (p<0.0001) than in controls were observed. In children with chronic C hepatitis statistically significant lower PAI-1 level (p<0.0001) and fibrinogen level (p<0.005) and higher PAP level (p<0.0001) and t-PA level (p<0.03) were found. There were no differences in fibrinolytic parameters levels between children with B and C hepatitis. CONCLUSION: Activation of fibrinolysis, especially plasminogenesis seems to be present in children with chronic viral hepatitis independently on type of hepatotropic virus.

[Tissue-type plasminogen activator (T-PA) and plasminogen activator inhibitor (PAI-1) in human follicular fluid during gonadotropin-induced ovulation]. / Stezenie tkankowego aktywatora plazminogenu i inhibitora aktywatorów plazminogenu typu 1 w plynie pecherzykowym u pacjentek leczonych metodami wspomaganego rozrodu.

OBJECTIVES: Plasminogen activators and their inhibitors have been implicated in the process of fibrinolysis, tissue remodeling, and ovulation. To evaluate the role of t-PA and PAI-1 in human ovulation, we obtained follicular fluid (FF) from preovulatory follicles of patients undergoing IVF-ET. Concentrations tPA and PAI-1 were analyzed in relation to oocyte maturation. Levels of tPA and PAI-1 obtained after COH were compared to the tPA and PAI-1 concentrations in the follicular fluid of healthy, fertile women. MATERIALS AND METHODS: FF was collected from 66 infertile patients undergoing ovulation induction using either short or long protocol. FF was obtained 36 hours after hCG (Pregnyl) administration. The control group consisted of 16 fertile women with unstimulated cycles. Concentrations of t-PA Ag and PAI-1 Ag were measured using Elisa kits (Bioopol). RESULTS: The average follicular fluid tPA concentration of patients undergoing IVF-ET treatment was significantly lower (0.039 vs 0.117 ng/mg protein; p < 0.0005), whereas PAI-1 significantly higher (3.261 vs 0.135 ng/mg; p < 0.0001) compared to the control group. Concentrations of tissue-type plasminogen activator in FF of patients with 5 or more mature oocyte were significantly lower (0.017 vs 0.056 ng/mg) and levels of PAI-1 higher (3.49 vs 2.9 ng/mg) in comparison to cases involving < 5 oocytes. CONCLUSIONS: 1. Concentration of tPA in the follicular fluid is significantly lower whereas PAI-1 level significantly higher in patients undergoing COH. 2. Follicular fluid tPA and PAI-1 concentrations may be a crucial factors reflecting oocyte maturity.

[Does extracorporeal circulation during coronary artery bypass grafting damage vascular endothelium?]. / Czy krazenie pozaustrojowe podczas pomostowania aortalno-wiencowego uszkadza komórki sródblonka naczyn?

The aim of the work was to study the influence of extracorporal circulation (ECC) on the vascular endothelial markers: von Willebrand factor (vWf), tissue plasminogen activator (t-PA) and trombomodulin (TM) in patients with coronary heart disease (CHD) undergoing coronary artery bypass graft (CABG). Examined group consisted of 30 patients (22 men, 8 women) at mean age 58.0 +/- 8.0 years, among them 19--were operated with ECC, 11--without ECC. Before and during operation blood was drawn 6 times. Control group consisted of 23. healthy volunteers at similar age. In the plasma vWf, t-PA and TM were determined with immunoenzymatic methods. Before operation the examined parameters were significantly higher compared to controls. The concentration of vWf during ECC was higher than in operation without ECC, but not significant. Differences statistically significant in the blood collected during ECC and without it appeared in t-PA only on the 3. and in TM on the 1. and 3. day after operation. It seems that ECC does not damage vascular endothelium direct, only indirect trough proinflammatory factors released from activated during ECC granulocytes and platelets.

[Plasmin-alpha 2-antiplasmin complexes in blood of patient with lichen planus against the background of other fibrinolysis parameters]. / Kompleksy plazmina-alpha 2-antyplazmina na tle wybranych parametrów fibrynolizy we krwi chorych na liszaj plaski.

The aim of the present study was to evaluate fibrinolysis in patients with lichen planus. In blood of 20 patients (12 women, 8 men) the levels of tissue type plasminogen activator (t-PA), plasmin-antiplasmin complexes (PAP) and D-dimer were examined. The control group consisted of 37 healthy volunteers. The concentrations of t-PA, PAP and D-dimer were higher in patients with lichen planus in comparison with the control group. It seems that increased level of t-PA antigen in the blood of the patients with lichen planus was the effect of t-PA releasing from endothelial cells. The results of the present study suggest that increased concentrations of t-PA antigen, PAP and D-dimer were the evidence of higher activity of fibrinolysis system in subjects with lichen planus.

[E selectin of blood in patients with unstable angina pectoris]. / Selektyna E we krwi chorych na niestabilna dusznice bolesna.

Adhesive molecules released from cellular surface, detected in body blood and liquids were determined as soluble or circulatory. In immunologically inflammatory process resulting from endothelium damage E-selectin is undoubtedly involved. The aim of this investigation was the concentration assessment of soluble E-selectin in blood serum in patients suffering from unstable angina pectoris. The expanding atheramotous process may bring about vascular endothelium dysfunction. In blood serum with citrate of 94 angina pectoris patients one found statistically higher E-selectin concentration than in control group. On the other hand, no statistically relevant differences were found pertaining to coexistent risk factors such as: high level of cholesterol in blood serum, hypertension, diabetes mellitus or smoking. Increased concentration was not age related. E-selectin was determined in citrate blood serum by ELISA immunoenzymatic method using Bender Medsystems kit.

Levels of F(1+2) prothrombin fragments and thrombin - antithrombin III (TAT) complexes in patients with dermatitis herpetiformis.

BACKGROUND: Dermatitis herpetiformis (DH) is a rare bullous disease of autoimmune etiology. It is an intestinocutaneous syndrome, in which vesicopapular cutaneous lesions are accompanied by gluten-dependent enteropathy. The diagnosis of DH is based on immunopathological investigation of unaffected skin fragment (granular IgA deposits present at the tops of dermal papillae and IgA - EmA present in the serum). MATERIAL/METHODS: The studied group consisted of 33 patients with dermatitis herpetiformis - 23 males and 10 females aged 22-78 (mean age 44.7). In all the patients, the following parameters of blood coagulation systems were determined in the plasma Levels of prothrombin fragments 1+2 (F(1+2)), levels of thrombin - antithrombin III (TAT) complexes, antithrombin III activity (AT III). RESULTS: In patients with dermatitis herpetiformis, the main level of F(1+2) fragments amounted to 9.08 nmol/l, as compared with 1.14 nmol/l in the control group (the difference statistically significant, p<0.0001). In DH patients, the levels of TAT complexes were over twice higher than among the controls and that difference also reached statistical significance (p<0.0001). Mean antithrombin III activity (AT III) in patients with DH reached 102.60% and was similar to that observed in the control group (104.68%). CONCLUSIONS: In patients with dermatitis herpetiformis, increased levels of F(1+2) prothrombin fragments and TAT complexes indicate enhanced in vivo thrombinogenesis. No statistically significant differences of F(1+2), TAT and AT III levels in DH patients related to their sex, age and duration of the disease were observed.

Post-traumatic plasminogenesis in intraarticular exudate in the knee joint.

BACKGROUND: Intraarticular exudate, observed in the knee joint a few weeks after a traumatic incident, is one of post-traumatic complications. Evacuation of the exudate prevents damage of the articular cartilage by the fluid possessing potent proteolytic properties. In view of the lack of data concerning the role of the fibrinolysis system in proteolytic destructive processes induced by the exudate, the aim of the study was to find out whether plasmin is present in the post-traumatic intraarticular exudate and whether it is generated in connection with excessive plasminogen activator levels or deficiency of plasminogen activator inhibitors in the synovial fluid. MATERIAL/METHODS: 55 patients (mean age 35.1), with history of knee joint traumas and exudate appearing in the joint at least 3 weeks post-traumatically. The patients and 30 healthy controls were subjected to the following tests of the synovial fluid and plasma: the levels of tissue plasminogen activator, type 1 plasminogen activator inhibitor, plasmin-alpha 2-antiplasmin complexes, fibrinogen and von Willebrand factor antigen, the activity of urokinase plasminogen activator, prekallikrein, alpha-2-antiplasmin, C1 inhibitor, type 1 plasminogen activator inhibitor, euglobulin clot lysis time. RESULTS: The patients' plasma demonstrated significantly higher levels of fibrinogen and PAP complexes, and decreased u-PA activity in comparison in that obtained from the controls. Significantly higher levels of PAP complexes and u-PA antigen were found in the exudate than in the patients' plasma. CONCLUSIONS: Local, intraarticular plasmin generation, probably u-PA-dependent, occurs in knee joint exudate. Plasminogen activator inhibitors are probably not very closely associated with increased intraarticular plasminogenesis.

Level of antithrombin III, protein C, protein S and other selected parameters of coagulation and fibrinolysis in the blood of the patients with recurrent deep venous thrombosis.

BACKGROUND: Thrombophilia is caused mainly by disturbances of hemostasis involving excessive coagulation system activation, reduction of anticoagulation system (antithrombin III, protein C, protein S, RAPC) or fibrinolytic activity. MATERIAL/METHODS: In 34 young patients (aged <40 years) with recurrent deep venous thrombosis (>2 incidents) the activity of antithrombin III, protein C, S, platelet count, adhesion and aggregation, APTT, stipven-kephalin, prothrombin time and INR were investigated. Fibrinogen, factor XIII, ELT, FDP, Ag t-PA levels, antigen concentration and PAI-1 activity were determined. Patients with idiopathic DVT, after elimination of most important thromboembolism risk factors, were qualified for the study. DVT was confirmed in all patients by phlebography, plethysmography and ultrasonography. Results were compared with a group of 54 healthy controls. RESULTS: In almost 50% of patients with recurrent DVT (15/34) decrease of at least one plasma coagulation inhibitor (AT III, PC, PS) level was observed. In the patient group (with AT III and/or PC and/or PS decrease) statistically significant reduction of kaolin-kephalin time in comparison with controls was observed (a<0. 01). Analysis of fibrinolysis system demonstrated significant factor XIII level decrease (to 58.3%), fibrinogen level increase, ELT prolongation, and fibrinogen and fibrin degradation product increase in comparison with controls. The patients demonstrated 3-fold higher t-PA antigen level (13.1 ng/ml, a<0. 0001) and over 3-fold higher PAI-1 activity (26.7 AU/ml, a<0. 001) than healthy controls. CONCLUSIONS: Reduced antithrombin III, protein C, protein S activity and excessive activation of the coagulation system with secondary fibrinolytic activity increase were found in patients with recurrent DVT.

Selected parameters of fibrinolysis system in patients with dermatitis herpetiformis.

BACKGROUND: Dermatitis herpetiformis (DH) is a very rare bullous dermatitis of autoimmune origin. It is a syndrome involving dermal and intestinal pathology, in which vesicopapular skin lesions are accompanied by gluten-dependent enteropathy. The diagnosis of DH is based on immunopathological investigation of unaffected skin bioptate (presence of granular IgA deposits in the upper portions of dermal papillae). MATERIAL/METHODS: The study was carried out in a group of 33 patients, including 23 males and 10 females aged 22-78 (mean age 44.7 years). The following fibrinolysis system parameters were determined in the sera of all patients: tissue plasminogen activator concentration (t-PA: Ag), urokinase plasminogen activator concentration (u-PA: Ag), plasminogen activator inhibitor concentration (PAI-Ag), plasminogen level, alpha-2 antiplasmin activity (alpha-2-AP), plasmin-- alpha-2 antiplasmin complexes concentration (PAP). RESULTS: Mean t-PA concentration in DH patients was 5.52 ng/ml, vs. 4.8 ng/ml in controls. The respective u-PA concentrations amounted to 0.33 ng/ml, and 0.39 ng/ml. PAI-1 concentration was markedly higher in DH patients (36.2 ng/ml) than in controls (22.40 ng/ml), whereas plasminogen level was significantly lower (86.0% vs. 115.9%). In patients, alpha-2-AP activity was 92% and was lower than in controls -103.4%. DH patients demonstrated also higher concentrations of PAP complexes (327.45 ng/ml) than the control group (203.03 ng/ml). CONCLUSIONS: Patients with DH were found to have lower plasminogen and alpha-2 antiplasmin levels and increased concentrations of PAP complexes, which indicates increased plasminogenesis in vivo. Increased type 1 plasminogen activator inhibitor level (PAI-1) may reflect a chronic inflammatory condition present in DH patients.

Antibodies to Chlamydia pneumoniae and haemostatic factors in acute coronary syndrome without ST segment elevation.

BACKGROUND: Various chronic infections, including Chlamydia pneumoniae (C. pneumoniae), are regarded as one of the possible factors which initiates, progresses and exacerbates atherosclerotic process. The relationship between C. pneumoniae infection and haemostatic factors which also may promote atherosclerosis, has not yet been established. AIM: To assess the relationship between C. pneumoniae-specific IgA and IgG serum antibodies and haemostatic factors in patients with acute coronary syndrome (ACS). METHODS: The study group consisted of 31 patients (17 males, mean age 62 years, and 14 females, mean age 60.6 years) with ACS and without ST segment elevation in whom antibodies to C. pneumoniae and such haemostatic factors as von Willebrand factor (vWF), thrombomodulin (TM), tissue plasmin activator (tPA), tPA inhibitor (PAI-1) and fibrinogen were measured. RESULTS: The proportion of patients with C. pneumoniae seropositivity was 35.4% in our study which is lower than that reported in literature. No significant relationship between vWF, TM, tPA and PAI-1 levels, and C. pneumoniae infection was found whereas a significant (p=0.05) relationship between C. pneumoniae-specific IgG antibodies and fibrinogen level was detected. CONCLUSIONS: Excluding fibrinogen, the presence of antibodies to C. pneumoniae is not associated with increased levels of haemostatic factors in patients with ACS without ST segment elevation.