[Removal of a dermoid cyst of the floor of the mouth in a patient with severe hemophilia A]. / Udalenie dermoidnoi kisty dna rta u bol'nogo tyazheloi formoi gemofilii A.

The article presents a case of a surgical treatment of removing a dermoid cyst of the floor of the oral cavity in a patient with severe hemophilia A. A detailed analysis was carried out of the surgical operation, postoperative management, coagulation factor replacement therapy and accompanying therapy, as well as the features of anesthesia, which allowed a surgical intervention without any hemorrhagic and infectious complications.

[Coagulological aspects of treatment of complications of prolonged therapy with warfarin]. / Koagulologicheskie aspekty lecheniia oslozhnenii prolongirovannoi terapii varfarinom.

The authors analysed the results of treating a total of 116 patients (68 men and 48 women aged from 20 to 84 years, mean age 59.5±15.5 years) presenting with various complications of prolonged therapy with warfarin. Prescription of prolonged therapy with warfarin had been caused by various cardiac diseases and lower extremity deep vein thromboses. The duration of anticoagulant therapy at the time of onset of complications was different and depended on the underlying disease. The majority of patients included into the study had been taking warfarin for one year and more, with nearly half of patients (48.1%) - for more than 5 years. Examination of patients included clinical, instrumental and laboratory studies, among which we determined standard laboratory parameters of haemostasis [activated partial thromboplastin time (APTT), international normalised ratio (INR), prothrombin index, prothrombin time, thrombin time, fibrinogen, etc.] and global tests (the thrombodynamics test and thromboelastogram). Amongst complications of prolonged warfarin therapy, 10 patients were found to have various thrombotic complications and 106 patients were diagnosed as having various by localisation and intensity haemorrhage. The obtained results of the study have demonstrated that the appearance of any thrombotic complications takes place occurs on the background of insufficient hypocoagulation and often require only correction of warfarin therapy. Whereas floating thrombi developing on the background of inadequate warfarin therapy require surgical management. Once haemorrhagic complications have developed, beside appropriate correction of warfarin therapy it is necessary to carry out correction of coagulopathies, which is done by means of different drugs and therapeutic regimens, whose choice should be based on assessing the clinical findings (localization and severity of haemorrhage) and laboratory indices, the main of which are local coagulologic tests, as well as global tests. The thrombodynamics test proved highly efficient for assessing the state of plasma haemostasis and predicting danger of the development of venous thromboembolic complications in patients with lower extremity deep vein thrombosis on the background of hyper- and hypocoagulation.

[EMERGENCY TREATMENT OF BLEEDING IN PATIENTS TAKING WARFARIN].

Anticoagulant therapy with vitamin K antagonists (AVK) is an effective treatment and prevention of thrombosis. One of the major disadvantages of the AVK is a risk for serious bleeding. Prothrombin complex concentrates (PCC), fresh frozen plasma (FFP) and vitamin K1 are available for control of these situations. The experience of special team ofthe Scientific Center for Hematology was the basis for presented retrospective study. Three regimens of warfarin-related bleeding were compared: PCC+ VK for several bleeding, FFP+ VK for different clinical situations and VKfor light bleeding. PCC showed himself as effective and safe hemostatic agent. Transfusions of FFP were sometimes not effective, sometimes led to TACO. Supplementation of vitamin K1 for patients of I and II groups provided more stable control of hemostasis. In III group VK vas effective to stop bleeding. Two impotent sings for conclusion: necessary of laboratory monitoring, TEG first of all; individual balance of hemostasis base of bleeding or thrombotic risks.

[Comparative evaluation of different tracheal accesses for artificial ventilation of the lungs in patients with depressed hematopoiesis]. / Sravnitel'naia otsenka razlichnykh dostupov k trakhee dlia provedeniia IVL u bol'nykh s depressiiami krovetvoreniia.

The purpose of this study was to analyze the complications and errors in tracheal intubation and tracheostomy, development of algorithm of steps for provision of endotracheal access in patients with hematological diseases. Provision of endotracheal access in 115 patients with blood system diseases is analyzed retrospectively. A total of 113 orotracheal, 50 nasotracheal intubations, and 48 tracheostomies were carried out. In 6 patients fibrobronchoscope was used for intubation because of pronounced hemorrhagic syndrome, inflammatory changes, and soft tissue edema of the face and neck; in 2 patients tracheostoma was inserted under local anesthesia. In 12 patients nasotracheal intubation was complicated by nasal bleeding. The most frequent and serious complication in patients with a tube in the trachea was obturation of the tube with sputum (9.7% of orotracheal intubations, 30% of nasotracheal intubations, and 15% of tracheostomas). Extubation/decannulation was carried out in 20 patients. One patient developed cicatricial stenosis of the trachea after tracheostoma. Hemorrhagic tracheobronchitis was endoscopically diagnosed most often (in 55 cases). Autopsy showed hemorrhages in the mucosa in 68.2%, in soft tissues adjacent to tracheostoma in 41.4%, and suppurative inflammation in 15.2% cases. Hence, hemorrhagic tracheobronchitis, hemorrhages in the mucosa, soft tissues of the trachea and bronchi are the most frequent clinical and morphological complications in patients with depressed hemopoiesis. Indications for nasotracheal intubation in this patient population should be limited. Early tracheostomy is recommended. Algorithm of steps ensuring the patency of airways in patients subjected to forced ventilation of the lungs is offered.

[Atypical electrolytic disorders in patients with diseases of the blood system]. / Netipicheskie élektrolitnye narusheniia u bol'nykh s zabolevaniiami sistemy krovi.

AIM: To describe and analyze rare iatrogenic disturbances of water-electrolyte and acid-base balances in systemic blood diseases. MATERIAL AND METHODS: Five cases of life-threatening electrolytic imbalance resultant from therapy in patients with hemoblastoses and a patient with acute intermittent porphyria (AIP). RESULTS: Hyperkalemia arose in 2 patients treated with cyclosporin A and trimethoprim-sulfamethoxasole. One patient developed severe arrhythmia because of hypomagnesemia following long-term therapy with aminoglycosides and amphotericin B. In one AIP patient hyponatremia ending in coma was attributed to the disease activity and infusion therapy. This was the cause of coma. In a patient with acute leukemia and pneumonia amphotericin B therapy entailed distal renal tubular acidosis and marked dyspnea which was primarily mistaken for acute respiratory failure. Pathogenetic, diagnostic and therapeutic aspects of the above water-electrolyte defects are provided. CONCLUSION: The appearance of water-electrolyte imbalance in hemoblastosis patients calls up a detailed analysis of the going-on therapy whether the imbalance is iatrogenic.