[Laboratory signs of activation of the hemostasis system in patients with coronary heart disease, who had coronary artery bypass surgery.]

The hypercoagulable state is a risk factor for shunt thrombosis in patients who had coronary artery bypass surgery. That is why the study of factors and operative intervention which can lead to hypercoagulable states are extremely valuable and vital issues. 85 patients who had coronary artery bypass surgery were examined. 40 of them have 2 type diabetes mellitus. All patients underwent a study of the content of fibrinogen, soluble fibrin-monomer complexes, D-dimers, von Willebrand factor, induced platelet aggregation in the blood on the 14th day after the surgery. There were no significant differences in content of fibrinogen, soluble fibrin-monomer complexes, D-dimers, induced platelet aggregation in the blood between patients with diabetes mellitus and patient without diabetes mellitus. It was detected the connection between separate indicators of the hemostatic system studied and age, height, weight, waist circumference and how long ago myocardial infarction had occured. It was detected that indicators of induced platelet aggregation correlate with indicators of lipid metabolism and degree of coronary artery stenosis. According to the information received, progression of hypercoagulable state after coronary artery bypass surgery is depends on weight, waist circumference, age, how long ago myocardial infarction had occurred, indicators of lipid metabolism and degree of atherosclerotic cardiovascular disease of coronary arteries.

[Pulmonary fibrosis as the first manifestation of scleroderma systematica overlap syndrome].

The paper describes a clinical case of a female patient with signs of visceral scleroderma systematica and rheumatoid arthritis (RA). Interstitial pulmonary fibrosis was the first manifestation of overlap syndrome. The articular and cutaneous of the syndrome were moderate and cast doubts upon whether the systemic rheumatic disease was present. Postmortem examination confirmed the presence of pulmonary fibrosis, scleroderma, and RA. The case is of interest from the point of view of the atypical onset of the disease.

[A case of multifocal fibrosis].

We report a case of multifocal fibrosis extending retroperitoneally (Ormond's syndrome) with urinary tract obstruction and bilateral ureterohydronephrosis that resulted in chronic renal insufficiency. The development of mediastinal and pericardial fibrosis was accompanied by clinical symptoms of exudative and constrictive pericarditis. Fibrosis of cardiac conducting system was associated with compromised sinus node and intraventricular blockade. Paraaortic, paraorbital, and periportal extension of fibrosis was documented. Diagnosis was made based on clinical observations and results of MSCT. Duration of the disease was 20 years. Immunosuppressive therapy failed to improve the patient's condition because of irreversible structural and functional changes in the organs.

[Changes in coagulation hemostasis in patients after coronary bypass surgery].

Changes in the coagulation link of hemostasis were studied in 37 patients who had undergone coronary bypass surgery using venous and arterial conduits and in 16 healthy individuals of the same age. The recordings of hemostasiograms were examined before and 14 days after surgery. Prior to coronary bypass surgery, the patients with ischemic heart disease were found to have coagulation hemostatic disorders as moderate hyperfibrinogenemia, fibrinolytic suppression, thrombinemia, and elevated D-dimer concentrations. Postoperatively, hypercoagulation substantially increased with suppressed fibrinolysis and decreased anticoagulants in the protein C system. In this connection, it is necessary to longer use anticoagulants in the postoperative period and to thoroughly monitor hemostasiogram recordings after their discontinuance.

[Stress-dependent lesions of the gastroduodenal mucosa during operations with cardiopulmonary bypass].

A continuous retrospective study was conducted in order to reveal risk factors and optimal ways of prophylaxis of gastroduodenal hemorrhage after operations with cardiopulmonary bypass. All the 559 cases operated on with cardiopulmonary bypass in Department of Cardiosurgery of Omsk Regional Clinical Hospital between January 2003 and December 2005 were analyzed. Risk factors and the effectiveness of different methods of antisecretory prophylaxis of hemorrhage were evaluated. It was found that the frequency of postoperative gastroduodenal hemorrhage was influenced by the degree of circulatory insufficiency, duration of artificial lung ventilation, cardiopulmonary bypass, and aortal occlusion, as well as application of anticoagulants and the frequency of gastric and duodenal erosions or ulcers prior to operation. The most effective means of prophylaxis was omeprazole administered intravenously during three days followed by oral application during three weeks. A short course of H2-histamine blockers discontinued abruptly increased hemorrhage-related lethality in this group of patients due to withdrawal syndrome.

[Peptic ulcers of the gastroduodenal zone in patients with scheduled cardiac operation: continuum of heterogeneous pathogenetic effects].

The article is a review of different pathogenetic mechanisms (infectious, NSAID-associated, stress-dependent and those stipulated by microcirculation disturbances in the gastroduodenal zone) of stomach and duodenum ulcers in patients with scheduled surgical intervention on the heart with the use of cardiopulmonary bypass. Some vexed questions related to treatment tactics of peptic ulcers in these patients are discussed.

[A case of multiple exostotic chondrodysplasia in combination with Wolf-Parkinson-White syndrome]. / Sluchai sochetaniia mnozhestvennoi ékzostoznoi khondrodisplazii i sindroma Vol'fa-Parkinsona-Uaita.

A case of a rare combination of two congenital diseases--multiple exostotic chondrodysplasia and Wolf-Parkinson-White syndrome--is reported. The disease ran with episodes of cardiac fibrillation. The patient died suddenly.

[Left ventricular remodeling in mitral valve defects]. / Remodelirovanie levogo zheludochka serdtsa pri mitral'nykh porokakh.

Left ventricular (LV) structure and function were studied in 199 with mitral valve defect before operation and in 88 patients after mitral valve replacement. LV structural-geometric shifts precede functional ones and can predict the latter. The rate of LV pathological remodeling depends on LV cavity volume and myocardial mass. Criteria of developing pathological LV remodeling are supposed to be the following: an increase in the myocardial mass index up to 225 g/m2 in 2H/D > 0.29, up to 175 g/m2 in 2H/D < 0.30; LV cavity dilation to 7 cm in diastole and 5 cm in systole.