Diagnostic levels of sepsis biomarkers in children with oncological diseases.

The data on the diagnostic levels of sepsis markers in blood plasma in 117 patients with oncological diseases at the age from 1 to 18 years are presented. The patients were divided into 4 groups depending on the outcome of the clinical course of the inflammatory process or infectious complications: group 1 - patients with no complications of anticancer treatment (n = 13/11.1%), group 2 - the presence of a systemic inflammatory response in patients (n = 64/54.7%), group 3 - patients with sepsis (n = 27/23.1%), group 4 - patients with septic shock (n = 13/11.1%). The threshold level of presepsin between groups 1 and 2 was 202 pg/ml, 371 pg/ml between groups 1 and 3, 604 pg/ml between groups 2 and 3 and 1500 pg/ml between groups 3 and 4. For procalcitonin, the threshold level between groups 1and 2 was 0.23 ng/ml, 0.48 ng/ml between groups 1 and 3, 0.51 ng/ml between groups 2 and 3 and 3.9 ng/ml between groups 3 and 4. The threshold value of C-reactive protein in patients with solid tumors was 12.6 g/l between groups 1 and 2. In patients with oncohematological diseases, the threshold level of C-reactive protein was 43.4 g / L between groups 2 and 3, 77.1 g / L between groups 2 and 4. According to the ROC analysis, presepsin was superior to procalcitonin and C-reactive protein in the diagnosis of septic complications.

[Use of 'Korona' cava filter in oncological patients]. / Primenenie kava-fil'tra 'Korona' u onkologicheskikh bol'nykh.

Using the 'Korona' cava filter in a total of 1345 oncological patients revealed regularity of a change in the shape of the inferior vena cava at the level of implantation. This made it feasible to determine one of the causes of long-term complications following implantation of other models of cava filters. The absence of clinically significant complications in the remote period after using this model of cava filter made it possible to implant it for a longer period, which is of special importance in oncological patients.

[Modern ferrokinetics metabolites in the diagnostics of anemic in patients with disseminated stages of Hodgkin's lymphoma when conducting intensive chemotherapy.]

Evaluation of anemic syndrome (AS) was performed in 79 patients with advanced stages of Hodgkin's lymphoma (LH) at various stages of chemotherapy (CT) according to the EACOPP-14 scheme. Against the background of the treatment, the number of erythrocytes and, accordingly, the HCT indices decreased with each subsequent cycle of chemotherapy (CTC) and reached the maximum reduction to 5, 6 th CCT. Absolute iron deficiency (IDA), which was combined with a low level of EPO and an inadequate degree of anemia, was found in a few LH patients (5 people, 6.3%). Functional iron deficiency (FDZH) was diagnosed in 9 patients (11.4%), had the same morphological signs as IDA. Namely, microcytosis, erythrocyte hypochromia and low hemoglobin content in reticulocytes (RET-HE). In contrast to IDA, patients with FDZh concentration of FR, GP-25 and IL-6 were high. Despite the fairly large reserves of iron, the level of rRTF testified to the "iron hunger" of the erythrocariocytes of the bone marrow, its index exceeded the upper limit of the norm, while RET-HE was low. In 34 (43%) patients, LH revealed a deficiency of endogenous erythropoietin (EPO), which was observed not only in patients with AHZ, but also in patients with IDA. Lower levels of EPO were detected in patients with leukopenia and very low erythropoietic activity of the bone marrow.

[Development of strategic approaches to modern diagnosis of anemic syndrome in patients with breast cancer.]

A study of the clinical analysis of blood and major metabolites of ferrokinetics in 107 breast cancer patients before treatment was conducted. In 31 (28.9%) patients revealed anemic syndrome (AS). A feature of the AS is pronounced microcytosis, erythrocyte hypochromia and low hemoglobin content in reticulocytes. Most often (n = 22; 71%) there was iron deficiency (IDA), which was characterized by a low concentration of iron (F), ferritin (FR), hepcidin 25 (GP25), interleukin-6 (IL-6) and high - soluble transferrin receptors (rTFR), transferrin (TRF). In 9 (29%) patients with AS, on the basis of a high concentration of FR, GP25, IL-6, the anemia of chronic disease (AHZ) with functional iron deficiency (FDI) was established. In 23 (74.2%) patients with AS, the was a deficiency of erythropoietin (EPO), the lowest rates were found in the group of patients with a common tumor process and FDI, with less in patients with IDA.

[The disorders of hemostasis system and thrombotic complications in oncologic patients having liver operation.]

The surgical interventions in patients with malignant tumors of liver cause a development of various forms of syndrome of disseminated intravascular coagulation (DIC) with significant increasing of concentration of markers of intravascular blood coagulation against the background of dramatic decreasing of activity of factors of prothrombin complex, level of natural anti-coagulants and components of fibrinolytic system. The thrombosis of veins of various localization developed in 12 patients with subacute form of DIC. The application of low-molecular heparin in combination with concentrate of anti-thrombin III and freshly frozen plasma decreases intensity of intra-vascular blood coagulation and results in reduction of factors of coagulation and is an efficient and adequate method of treatment of thrombosis and thromboembolism of pulmonary artery in oncologic patients. The significant increasing of level of D-dimer, von Willebrand factor against the background of dramatic decreasing of prothrombin activity, content of antithrombin III and level of plasminogen are hemostasiologic factors of development of severe liver insufficiency. The corresponding timely diagnostic and correction permits to ameliorate results of surgical treatment of patients with malignant tumors of liver.

[The disorders of hemostasis and their prevention with low-molecular heparins in oncological patients].

The patients with malignant neoplasms are subjected to high risk of development of venous and arterial thromboembolic disease. The development of thrombosis complicates treatment and deteriorates indicators of survival. The alterations in the system of hemostasis brought on by both tumor and methods of treatment play the main role in pathogenesis of thrombotic complications in oncological patients. The application of low-molecular heparins (Klexan and Fraxiparine) prior to operation and during post-operative period decreases activation of pro-coagulant (prolongation of activated partial thromboplastin time, pro-prothrombin activity and concentration of fibrinogen) and platelet-derived components of system of hemostasis, level of markers of intravascular coagulation of blood, von Willebrand factor. The low-molecular heparins favor preservation of natural inhibitors of thrombin and support protective function of fibrinolytic system. In the group of patients with tumors of locomotor apparatus receiving no pharmaceutical prevention thrombotic complications developed in 13% of cases and in the group of patients receiving Klexan complications developed in 2% of cases. In the group of patients with oncological gynecological patients receiving no pharmaceutical prevention thrombotic complications developed in 13% of cases and in the group of these patients receiving Fraxiparine thrombotic complications developed in 6% of cases and in the group of patients receiving Klexan thrombotic complications developed in 5% of cases. In oncological patients during the period of anti-tumor treatment the intensity of intravascular coagulation of blood is increased. The application of low-molecular heparins against the background of antitumor therapy decreases activation of intravascular coagulation of blood and rate of thrombotic complications. In the group of patients receiving no pharmaceutical prevention the thrombotic complications developed in 21% of patients and in the group of patients receiving low-molecular heparins the complications developed in 4% of patients.

[Determination of anti-Xa activity in cancer patients].

Low molecular-weight heparins (clexan, fraxiparin, fragmin) were used in cancer patients to prevent hemostatic system disorders and related complications. The adequacy and safety of therapy were assessed measuring plasma anti-Xa activity in 239 patients. When the prophylactic doses of the low molecular-weight heparins clexan, fraxiparin, and fragmin were given, their anticoagulative effect was similar as judged from anti-Xa activity. Clexan exhibited the maximum anti-Xa activity when the therapeutic doses of the low molecular-weight heparins were used.

[Low molecular-weight heparin (clexane) in the prevention of thrombotic events in patients with malignancies].

The basic links of the hemostatic system and the markers of intravascular thrombogenesis were studied, by using an automatic STA Compact analyzer in 80 patients with locomotor tumors. The patients were divided into 2 groups: 1) 50 patients received clexane, 40 mg, 12 hours before and within 7-18 days after surgery (a study group); 2) 30 patients underwent only nonspecific prevention of thrombotic events (a control group). Postoperatively, hypercoagulation was shown to persist long (up to 18 days) in patients with locomotor tumors. Clexane used in the pre- and postoperative periods within 18-20 days was effective in reducing the rate of intravascular blood coagulation, preventing thrombotic events, and failing to cause hemorrhages.

[The clinical value of D-dimer in the diagnosis and treatment of thromboembolic complications and DIC syndrome in cancer patients].

The content of D-dimer was studied in 130 patients with cancer at various sites. Twenty-five patients were diagnosed as having pulmonary thromboembolism (PTE), 30 had venous thromboses, and 35 patients had acute and subacute disseminated intravascular coagulation (DIC) syndrome. A control group included 40 patients without thrombotic complications. The studies were performed on an automatic STA COMPACT analyzing device. It has been shown that there is a drastic (10-15-fold) increase in the content of D-dimer as compared with the controls. The highest level of D-Dimer was observed in patients with acute DIC who have significant clinical symptomss. The level of D-dimer was to a lesser extent increased in patients with multiple organ deficiency. The content of D-dimer decreased during therapy anticoagulant therapy. When PTE, venous thrombosis, or DIS are suspected, it is advisable to include the study of D-dimer into a coagulogram.

[Intraoperative infusion-transfusion therapy in pediatric surgical oncology]. / Intraoperatsionnaia infuzionno-transfuzionnaia terapiia pri operatsiiakh v detskoi onkologii.

Modern concept of intraoperative blood loss compensation differs crucially from the old rule to compensate the blood loss by donor blood in the same volume, which is explained by serious risks associated with blood transfusions. The parameters of infusion/transfusion therapy with 6% Infucol GEK are presented. The drug was used with good results in adults and children. Volemic parameters are presented and dynamic changes in the blood clotting system after transfusion of infucol GEK and Russian colloid preparation polygluquine are analyzed. Infucol GEK improved vascular blood filing and decreased the volume of other preparations used for blood loss compensation.

[Effects of theraphthal-Lio on hemostasis in experimental animals]. / Vliianie teraftala-Lio na gemostaz zhivotnykh.

Teraphtal-Lio (Tph) exerted a toxic dose-dependent effect on the hemostatic system. Treatment of experimental animals with maximum tolerated and highly toxic doses was followed by acute DVS syndrome formation involving a hemophilic condition, soaring activated partial prothrombin time, absence of fibrinogen, sharp rise in fibrinogen degradation product and D-dimer matched by fall in thrombocyte count. No toxic influence on the hemostatic system was registered when Tph doses recommended for humans in the course of phase II clinical trials were administered to animals.

[Hemostasis disorders in cancer patients with massive intraoperative blood loss]. / Narusheniia sistemy gemostaza u onkologicheskikh bol'nykh s massivnoi intraoperatsionnoi krovopoterei.

The hemostasis system was examined before, during, and after surgery in 130 patients with blood loss from 50 to more than 200% total circulatory volume. Blood loss caused deep changes in the hemostasis system, presenting as acute and subacute syndrome of different hypocoagulation degree in parallel with fibrinolysis activation of different intensity, or as hemodilution coagulopathy, or combination of both. Laboratory signs of acute DIC syndrome anticipate its clinical manifestation, which allows rapid correction of the detected disorders and prevention of severe hemorrhages. A complex of methods for rapid diagnosis of coagulopathic hemorrhages is developed. Various approaches to the treatment of DIC syndrome during and after surgery were used in patients with massive blood loss.

[The effect of Clexane (low-molecular-weight heparin) on the hemostatic system and on the incidence of postoperative thrombotic complications in gynecological cancer patients]. / Vliianie kleksana (nizkomolekuliarnogo geparina) na sistemu gemostaza i chastotu posleoperatsionnykh tromboticheskikh oslozhnenii u onkoginekologicheskikh bol'nykh.

Clexane in a dose of 40 mg before and after surgery notably decreased the intensity of chronic intravascular blood coagulation during surgical treatment of oncogynecological patients. Only 3% patients developed thrombosis of deep veins of the lower limbs after Clexane, while in the group administered no Clexane, 20% developed this complication. Preventive administration of Clexane did not cause an increase of the operative blood loss. The incidence of wound hematomas in patients administered Clexane and nonfractionated heparin was negligible and virtually the same.

[The diagnosis and correction of hemostatic system disorders during surgical coagulopathic hemorrhages in cancer patients]. / Diagnostika i korrektsiia narushenii sistemy gemostaza vo vremia operatsionnykh koagulopaticheskikh krovotechenii u onkologicheskikh bol'nykh.

The hemostasis system was examined before surgery, during the principal stages of the operative intervention, and in the early postoperative period in 280 patients with various malignant tumors. The volume of intraoperative blood loss varied from 280 to 14,000 ml. The studies revealed that the main factor causing the most profound disorders in the hemostasis system which lead to the development of grave coagulopathic hemorrhages is blood loss due to surgical trauma. Coagulopathic bleedings most frequently develop in case of at least a 3000 ml blood loss and course as different variants and stages of the syndrome of disseminated intravascular coagulation (DIC) or hemodilution coagulopathy. Massive blood loss was found to involve primarily damage of the platelet component of the hemostasis system, thrombocytopenia being paralleled by a drastic reduction of the aggregability of these cells, this, in turn, increasing bleeding from small vessels. Laboratory signs of acute DIC diagnosed during surgery anticipate its clinical manifestation. Working classification of operative bleedings and rapid methods for their diagnosis have been developed.

[Coagulopathic hemorrhages in the surgical treatment of cancer patients]. / Koagulopaticheskie krovotecheniia pri khirurgicheskom lechenii onkologicheskikh bol'nykh.

The hemostasis system was examined before surgery, during the principle stages of the intervention, and in the immediate postoperative period in 280 patients with various malignant tumors. The volume of blood loss during the operation varied from 280 to 14,000 ml. The studies demonstrated that blood loss due to traumatic surgical interventions is the principal factor causing the most profound disorders in the hemostasis system leading to the development of grave coagulopathic hemorrhages in cancer patients. Coagulopathic bleedings most frequently develop at a blood loss of more than 3,000 ml and course as variants and stages of the disseminated intravascular coagulation (DIC) syndrome or hemodilution coagulopathy. A massive blood loss was found to be detrimental primarily for the platelet component of the hemostasis system; besides thrombocytopenia, the aggregability of these cells reduced, this being conducive to development of hemorrhages from the small vessels. Laboratory signs of acute DIC syndrome diagnosed during surgery were shown to anticipate its clinical manifestation. A working classification of surgical hemorrhages and rapid methods for their diagnosis have been developed.

[The diagnosis and prevention of hemostatic system disorders in the surgical treatment of patients with cancer of the large intestine]. / Diagnostika i profilaktika narushenii sistemy gemostaza pri khirurgicheskom lechenii bol'nykh rakom tolstoi kishki.

The hemostasis system was studied before, during, and after surgery in 40 patients with colonic cancer administered no pretreatment and in 30 ones administered depogen before the operation and its combination with heparin after surgery. Preoperative depogen had a positive impact on both the coagulation and platelet components of the hemostasis. Depogen in complex with heparin reduced the intensity of subacute chronic intravascular blood coagulation during and after the operation and was conducive to a decrease of the incidence of postoperative complications in patients with colonic cancer.

[Prevention of hemostatic disorders at different stages of surgical treatment in patients with colonic cancer]. / Profilaktika narushenii sistemy gemostaza na razlichnykh étapakh khirurgicheskogo lecheniia bol'nykh rakom tolstoi kishki.

The status of the hemostasis system was studied in 40 patients with colonic cancer before, during, and after surgery, who were administered no treatment before the operation, and in 30 ones administered depogen with heparin in the preoperative period. Preoperative treatment with depogen had a favorable effect on both coagulation and platelet components of the hemostasis system. Administration of depogen together with heparin reduced the intensity of subacute chronic intravascular blood coagulation during and after surgery in patients with colonic cancer and was conducive to a reduction of the incidence of postoperative complications.

[The effect of antioxidants on the hemostasis system in patients with cancer of the lung]. / Vliianie antioksidantov na sistemu gemostaza u bol'nykh rakom legkogo.

Addition of drugs improving blood viscosity to premedication with antioxidants promotes to normalization of platelet function, thus attenuating the intensity of chronic intravascular coagulation syndrome and improving the state of microcirculation in patients with lung cancer. The above premedication decreases the incidence of postoperative complications.