Socio-economic assessment of patient blood management practical implementation in surgical treatment of coronary heart disease (I20-I25).

Aim    To evaluate possible social and economic benefits of correcting preoperative iron deficiency /iron deficiency anemia as a comorbidity in a model population in the process of transition from the routine practice to the optimized preparation of patients to elective surgery (as exemplified by several circulatory diseases: I20 - I25, class IX ICD 10).Material and methods    By building imitation models depending on the patient blood management (PBM) practice, changes in years of life lost/saved adjusted for disability were evaluated, including in monetary terms, in relation to the annual number of operations performed for ischemic heart disease (IHD) (I20 - I25) in the age group of 17 years and older, as well as a potential effect of PBM on the applied health economics.Results    With implementation of the PBM systemic measures in cardiac surgery, the potentially prevented annual social and economic damage will amount to more than 38 thousand years of life saved and more than 20.2 billion rubles in monetary terms. Furthermore, it will be possible to exclude 9435 hemotransfusion from the cardiosurgical practice, which will annually save more than 2.3 thousand liters of blood with a total cost of 77.7 million rubles in favor of clinical situations that have no alternative.Conclusion    The implementation of PBM in cardiac surgery, the discipline with the highest levels of preoperative iron deficiency/anemia and the use of blood components, will not only improve the clinical outcomes and cost-effectiveness of surgical interventions, but will also prevent social and economic damage to the country.

[The Clinical Economic Evaluation When Choosing and Purchasing Consumables: Optimization of Expenses of Medical Organizations].

The article presents a description of the new methodological guidelines and substantiates its actuality for practical health care in conditions of budget limitations.

[Lipofuscin accumulation in the placenta in normal and gestosis-complicated pregnancy]. / Osobennosti nakopleniia v platsente lipofustsina pri normal'no protekaiushchei i oslozhnennoi gestozom beremennosti.

Fluorescent microscopic examination of 20 placental samples from women in whom pregnancy ran a normal course and from those who suffered from gestosis was carried out to study lipofuscin accumulation in the placenta. Lipofuscin accumulation in the placenta was found to be a normal process, reflecting activation of lipid peroxidation. Placental lipofuscin accumulation was found higher in gestosis, this pointing to a reduction of the functional potentialities of the placenta. The maximum lipofuscin levels were detected in cases with gestosis associated with threatened abortion. Further investigation of this problem is necessary.

[Characteristics of the course of pregnancy complicated by gestosis]. / Osobennosti techeniia beremennosti, oslozhnennoi gestozom.

Analysis and statistical processing of 10758 labor histories of pregnant women with various gestoses, who delivered their babies at maternity home No. 27 in Moscow in 1986-87, has helped the author define the specific features of present-day gestoses, that are characterized by an increased incidence of combined forms, atypical and poorly manifest symptoms, predominance of neurocirculatory dystonia and obesity among other underlying diseases in combined forms, development of a number of complications that deteriorate maternal and fetal status in the presence of inapparent prolonged gestoses, and by abnormal amniotic condition resultant from the developing placental insufficiency.