Disseminated intravascular coagulation (DIC) is the most common disorder of hemocoagulation in clinical practice. It is found in many diseases, since the causes of its development are different. However, all etiological factors (physical, chemical, microbial and viral influences and malignant growth) are pathogenetically mediated through damage to cells and their membranes. Such damage results (usually in combination) in the release of tissue thromboplastin and intracellular proteinases into the bloodstream, as well as exposure of the subendothelium of blood vessels. These three consequences of cell damage act as primary specific initiators of blood coagulation by both external and internal mechanisms.
One of the methods of therapy, widespread in all areas of clinical medicine, is blood transfusion. The volume of blood transfusions varies, sometimes reaching several liters, especially in cardiovascular surgery and obstetrics and gynecological practice. Numerous experimental and clinical studies have established that the main, replacement function of blood transfusion is most pronounced in cases of acute blood loss, hemorrhagic shock and is due to the interrelated functioning of individual blood components of the recipient and donor.
Thrombolytic properties of terlitin obtained from the fungus Aspergillus terricola, when administered intravenously in animals with experimental thrombi were shown in the works of S.V. Andreev and coworkers, Y.D. Mamedov and coworkers. There are reports about the possibility of obtaining thrombolytic effect when using terlitin orally. Studies of several authors have established a change in the surface and shape of peripheral blood erythrocytes under various influences on the body. This paper presents the results of the experimental justification of the use of terlitin preparation by means of electron microscopic studies of erythrocyte surface.
Heparin in clinical practice is used either to prevent thrombosis or during extracorporeal hemoperfusion (hemo- and plasmabsorption, operation of artificial circulation devices and blood fractionators). Currently, indications for administration of heparin for therapeutic purposes tend to be limited. This is due to the fact that the vast experience of heparin therapy has revealed not only the favorable effects of heparin, consisting in its hypocoagulation action, but also the possibility of the development of various complications of its use. These adverse effects of heparin include primarily thrombocytopenia associated with intravascular platelet aggregation. In addition, in certain situations, heparin is able to block the action of antithrombin III in case of severe thrombinemia and antithrombin deficiency. Recently, data have appeared about the increase of platelet factor 4 concentration in plasma of patients with peripheral atherosclerosis during intravenous injection of heparin. Consequently, the search for compounds capable of replacing heparin is highly relevant.
Except such known inhibitors of proteolytic enzymes, as hirudin, bdellins and eglins, and also hyaluronidase enzyme, by us in a secretion of salivary glands of medical leeches the new enzyme destabilase which breaks isopeptide bonds in stabilized fibrin and having thrombolytic action, inhibitor of blood plasma kallikrein and prostanoids, on a spectrum of action similar to prostacycline and its stable analogues have been found. We show that the secret of leeches irrespective of presence in it hirudin suppresses platelet-vascular hemostasis, interfering adhesion of platelets on a surface of collagen and the aggregation of the platelets stimulated by inductors of various nature, by activation of adenylate cyclase of membranes of platelets [3]. Irrespective of the presence of hirudin, the secret blocks the contact stage of the internal mechanism of blood coagulation by inhibiting blood plasma kallikrein and Hagemann factor.
Calcium antagonists, in particular corinfar, are powerful arteriodilator drugs that have been successfully used recently in the treatment of arterial hypertension. It is known that changes in rheological properties of blood lead to circulatory disturbances in the smallest blood vessels. There are separate reports about the effect of corinthar on blood rheology parameters in patients with angina pectoris. We have not found any works about the effect of corinthar on blood rheological parameters in hypertensive patients in the available literature. Therefore, in the present study we made an attempt to study the effect of the drug on hemorheological parameters in patients with Stage II hypertension during a course of treatment.
According to modern concepts, intravascular coagulation of blood is of dominant importance in the pathogenesis of myocardial infarction. Development of DIC syndrome in patients with acute myocardial infarction is associated with the entry of a significant amount of procoagulant material into the bloodstream, which leads to a disorder in the hemostasis system with formation of microthrombi in arterioles, capillaries and venules of various organs with or without violation of their function. At the same time the fibrinolytic system is activated, which is accompanied by the cleavage of fibrin and fibrinogen and the appearance in the blood of products of their degradation (PDF).
Numerous studies have shown that intravascular thrombosis is one of the main causes of death in patients with coronary heart disease. Therefore, the issues of prevention of thromboembolic complications and development of the tactics of differentiated antithrombotic therapy in coronary heart disease, including chronic forms of the disease, are extremely relevant.
The aim of our study was to evaluate the effect of aspirin and voltaren on microcirculation, transcapillary exchange and hemocoagulation in patients with rheumatism. We studied 77 patients (31 men and 46 women) aged 16 to 57 years. Minimal degree of activity was found in 65 patients, moderate - in 12 patients.
One of the reserves for improving the effectiveness of treatment of severe craniocerebral trauma is the timely diagnosis of foci of cerebral hemorrhage and their surgical removal. However, the most common diagnostic methods (echoencephalography, electroencephalography, cerebral angiography) do not always allow differential diagnosis of foci of cerebral crush and foci of cerebral contusion. It can be assumed that in severe isolated closed craniocerebral trauma accompanied by foci of cerebral crush injuries, cerebral detritus in the form of cell membrane fragments will appear in the cerebrospinal fluid. Their reliable verification may become a valid diagnostic test for cerebral crush foci. We believe that the 5'-nucleotidase enzyme, firmly bound to the outer surface of the plasma membranes, can serve as a marker of cellular destruction.
The aim of this work was to study the relationship between changes in blood platelet sialic acid levels and adenine nucleotide pool regulation with the parameters of platelet hemostasis (adhesive-aggregation and retractile capacity of blood plates) in chronic myeloleukemia and idiopathic myelofibrosis. The studies were performed on platelets of healthy subjects (20), patients with chronic myeloleukemia (14) and idiopathic myelofibrosis (11) with advanced clinical manifestations.
The aim of this work was to study the disorders of blood coagulation system in breast cancer after surgical intervention and in the development of postmastectomy edema. 156 patients were examined before the treatment and in different terms after the operation (in 3, 14-16, 25-30 and 45-90 days). Hemostasis in 50 patients who underwent mastectomy more than 6 months ago was also studied: 29 of them had postmastectomy edemas of grade 0-II, and 21 patients had grade III-IV edemas.
We used radioisotope phlebography to assess the immediate and long-term results of 11 reconstructive surgeries on the main veins of the lower extremities, including cross femoral autovenous shunting for unilateral iliac vein occlusions and saphenous femoral shunting aimed at eliminating pathological reflux through the femoral vein.
The role of the saprophytic intestinal microflora is not limited to participation in the digestive process. Endotoxin (an obligatory component of the cell membrane of all Gram-negative bacteria) released as a result of self-renewal of the E. coli cell pool enters the portal bloodstream and performs antigenic stimulation of the macroorganism. In addition, a small amount of endotoxin can also be released by live Gram-negative bacteria, which under conditions of numerous E. coli populations in the intestine can create a fairly high concentration of endotoxin. It is possible that this is why the normal concentration of endotoxin in the blood of the intact rat portal vein is 5 ng/ml, although in humans it is much lower. It is believed that under physiological conditions all endotoxin is eliminated from portal blood by hepatic Kupffer cells.
The arsenal of means of therapeutic influence on the course of coronary heart disease has been supplemented by hemocarboperfusion relatively recently. The aim of our work was to study in detail the clinical effect of hemosorption in patients with unstable angina pectoris. Sixty-two male patients with coronary heart disease were examined. All patients were diagnosed with unstable angina by WHO criteria (1979), 31 of them had postinfarction cardiosclerosis. In 48 patients the duration of the disease did not exceed 5 years, in 14 - it was more than 5 years. Arterial hypertension was detected in 22 patients. The average age of the examined patients was 49.3 ± 6.2 years.
Hemosorption as a component of complex therapy was included in the treatment of 47 patients with reliable rheumatoid arthritis. Women predominated among the patients (35 out of 47). The patients were aged from 23 to 60 years (under 40 years - 19, over 40 - 28). Seventeen people had been ill for 1 to 5 years, 24 for 6 to 10 years, and 6 for 11 to 15 years. The disease progressed rapidly in 1 of the patients and slowly in 36 of them. Grade II process activity was found in 34 patients, and grade III - in 13 patients. Radiological stage I-II of the disease was detected in 16 patients, in 28 patients - III, in 3 - IV. I-II degree and 6 - III degree of functional insufficiency of joints were diagnosed in 41 patients. The seropositive variant of rheumatoid arthritis was found in 28 patients and seronegative - in 19 patients. All patients had oligopolyarthritis; 25 of 47 patients had systemic manifestations.
The aim of this work was to study the effect of the new drug dimefosfon on the acid-base status in patients with autoimmune thyroiditis and to clarify the possible mechanisms of its antiacidotic action. Dimefosfon was administered to patients with autoimmune thyroiditis orally three times at a dose of 100 and 25 mg/kg body weight per day for 3-4 weeks.
Endoscopic reduction of gastric secretion was used in the treatment of 38 patients with peptic ulcer disease with frequent or continuously relapsing type of course. All of them had been previously treated in a therapeutic hospital more than once, but with only temporary improvement. The age of the patients (35 male, 3 female) ranged from 22 to 55 years, mean age - 36 years. The average duration of the disease was 8.3±1.5 years. The nature of the ulcerous process was clarified endoscopically and radiologically; benign nature of the disease was verified by the results and morphological study of biopsy specimens. Bulbar ulcers were found in 34 patients, in 4 patients - pylorobulbar ulcers; 11 patients had multiple, "kissing" onion ulcers. The area of the ulcerous defects ranged from 0.15 to 1.3 cm2 (0.34 ± 0.03 cm2). Five patients had recurrence of sutured perforated ulcers, 3 patients had a history of bleeding.
One of the main reasons of insufficient efficiency of treatment of fresh forms of pulmonary tuberculosis and their subsequent outcome in fibrotic cavernous processes is premature discharge of patients from the hospital. According to V. D. Chernetsky, in 62.8% of cases it happens in the first 3 months, and in 49.3% of them - in the first month. Premature discharge is often caused by mental changes and concomitant chronic alcoholism which affect the attitude towards the disease. Studies of attitudes towards illness in pulmonary tuberculosis patients have been conducted mainly in the pre-treatment period and have been mostly descriptive in nature. At present, there is a disproportion between the level of somatic examination of a patient and the completeness of study of the patient as a personality.
The aim of our study was to investigate sacral reflex responses in patients with vertebrogenic lesions of the genital nerve. Recording of reflexes that were induced at the level of sacral segments was performed in the supine position of the patient. The study was performed on a 4-channel electromyograph M-42, which allowed recording the response with a significant latent period - up to 500 ms. To distinguish between the evoked response and dipping potentials more accurately, we applied the technique of superimposing several responses.
The origins of modern concepts of contact activation of blood clotting go back to the middle of the last century. In 1862, Lister drew attention to the fact that sheep's blood collected in a rubber test tube remained flowing significantly longer than that placed in a glass or ceramic cup. It was also observed that blood clotting was slower in tubes coated inside with oil or Vaseline. As a result, it was believed that blood-wetted contact surfaces (glass, etc.) promote rapid coagulation of liquid blood or plasma, while non-wetted (like paraffin), on the contrary, slow the clotting process.
The appearance of tissue thromboplastin (factor III, tissue factor) in the bloodstream leads to one of the most dangerous non-specific disorders of hemocoagulation - disseminated intravascular clotting (DIC). Although the components of the thromboplastin reaction are known, the molecular organization of tissue thromboplastin to the extent necessary to understand the initiation of the external pathway of the blood coagulation system has not been detailed to date.
Changes in the hemostasis system under extreme influences on the body have for many years been the subject of close attention of clinicians and pathologists. Particular interest in this problem is due to the most frequent in practice set of disorders known as disseminated intravascular coagulation (synonyms: thrombohemorrhagic syndrome, consumption coagulopathy, secondary fibrinolysis, hypofibrinogenemia, coagulopathic syndrome, etc.). Based on the modern concepts of shock as a process based on systemic disruption of microhemocirculation with inadequate tissue oxygenation and impaired cellular metabolism, the pathogenetic role of DIC becomes particularly significant.
At present there are a large number of drugs that can affect various parts of hemostasis. By the nature of the effect on the process of fibrin formation drugs are divided into Procoagulants (accelerating this process) and anticoagulants (inhibiting the formation of fibrin). Fibrinolysis activators and inhibitors are known and used in the clinic. A number of drugs affect cellular hemostasis, primarily on the adhesive-aggregative ability of blood forming elements. The action of many compounds on plasma and cellular hemostasis is mediated by their effect on. the vascular wall with subsequent release of regulators of blood clotting, fibrinolysis and aggregation of formular elements.
To find out the peculiarities of microcirculatory disorders in lobar pneumonia 35 patients were examined in dynamics. Along with the assessment of the activity and prevalence of the inflammatory process, state of external respiration and vegetovascular tone in the patients we carried out special studies: biomicroscopy of conjunctival vessels and thermotopography with determination of the difference between: a) chest and lower leg temperature - oral-caudal ratio (OC); b) proximal and distal limb skin temperature - proximal-distal ratio (PD); c) temperature in symmetrical skin areas - thermoasymmetry (TA). Corresponding indices in healthy individuals were 3,5 ±0,2, 2,2 ±0,19, 0,5 ±0,03°. The state of hemocoagulation and fibrinolysis was studied by thromboelastography, ethanol test, erythrocyte and platelet aggregation capacity, hematocrit.
We studied microcirculation and pulmonary diffusion capacity in 108 patients with systemic scleroderma (29) and chronic nonspecific lung diseases (79). There were 53 men and 55 women. The control group consisted of 33 healthy individuals-15 men and 18 women.
Atrial parasystole in children is more common than defined. It is an independent type of arrhythmia with high ectopic center activity. Diagnosis is possible only with electrocardiographic examination. For the left atrial form, the ECG of the right thoracic lead (V1) is the main element of examination. Atrial complex in V1 has a shield and sword shape (gentle ascending, terminal part of P,-high pointed). Electrocardiographic signs of atrial parasystole are temporal differences of pre-ectopic intervals, the multiplicity of inter-ectopic intervals, and the presence of confluent complexes.
Hypertrophic subaortic stenosis is a rare and poorly studied disease. However, in recent years, it has been detected more frequently due to the introduction of echocardiographic technique into clinical practice. This clinical case illustrates the importance of echocardiography in the diagnosis of this disease.
We performed a comparative assessment of changes in the parameters of central and peripheral hemodynamics, contractile and relaxation myocardial function of the left ventricle in patients with coronary heart disease under the influence of isoptin depending on the state of carbohydrate metabolism. We examined 53 male patients aged 36 to 64 years with chronic coronary insufficiency of degree I to II. The disease lasted on average 3.7 ±0.2 years, had no clinical signs of circulatory insufficiency and proceeded without concomitant arterial hypertension.
The aim of this work was to study the dynamics of blood lipid content in alcoholism. We examined 41 patients with stage II alcoholism and 10 healthy men (control group). The age of the patients ranged from 23 to 55 years. Blood for the study was taken in the morning on an empty stomach at the admission of patients and after 12 days of treatment in LTP.
Patients with mechanical injuries have more or less pronounced changes in circulating blood volume, which, of course, affects blood circulation and acid-base status. Therefore, one of the primary objectives of resuscitation aid is normalization of circulating blood volume. The amount and rate of infusion should be determined not by integral indicators of blood pressure and pulse, i.e. empirically, but individually for each patient.
Currently, our experience includes more than 40 percutaneous transhepatic cholangiographies using ultrathin Hiba needles and stiletto catheters, during which various X-ray endobiliary interventions were performed. Their standard program through the needle included cholangiography, washing of biliary tracts with physiological solution, extraction of contrast substance and bile after the study, intraductal antibiotic therapy, administration of antispasmodics.
In the available literature, we did not find any works that would reveal the peculiarities of the course of gestosis in pregnant women with polyhydramnios. In addition, it would be interesting to study the incidence of gestosis and its development, taking into account the possible causes of amniotic fluid, to assess the outcome of pregnancy for the mother and fetus when these complications are combined. A total of 161 pregnant women with abundant amniotic fluid were followed up, and 142 of them (88.2%) had gestosis. Pregnant women aged 20 to 30 years comprised the main population (61.3%).
We observed 50 patients (22 males and 28 females) with ear tumors from 1977 to the present. Two patients were younger than 20 years old, 8 patients were 21 to 30 years old, 13 patients were 31 to 40, 12 patients were 41 to 50, 6 patients were 51 to 60, and 9 patients were older than 61. Tumors and tumor-like masses of covering epithelium (19) and mesenchyme (16) were the most common, followed by nevi (9). Predominantly all of them were located in the auricle and the membranous part of the external auditory canal.
85 patients with chronic purulent maxillary sinusitis aged from 8 to 16 years were treated in the in-patient department. The duration of the disease was from 5 months to 12 years. The patients were divided into three groups, identical in gender and age.
The aim of the study was to investigate the medical and social aspects of children's ambulance attendance by examining each case of a call. The results are intended for rational organization of children's ambulance service, determining the profile and equipment of the brigades. We analyzed 331 pediatric ambulance calls to children under the age of 7 years.
Analysis of the historical development of medicine and pharmacy in the Middle Volga region in XVI - XVIII centuries is of undoubted interest. During this period, the supply of medicine to the population was carried out mainly through herbal shops and trading rows [1-3, 7], which led to the abuse of potent and poisonous medicines. The use of local resources was extremely insignificant, medicines were mainly imported from abroad - from the West by healers, from the East by merchants (cinquefoil, rhubarb, camphor, musk, cloves, almonds, chilibukha).
Professors V. S. Shchelkunov, O. V. Alexandrov, V. M. Kassil, H. R. Paleev, M. M. Seredenko, V. N. Abrosimov, A. G. Marachev made reports on diagnosis, treatment of patients with acute and chronic respiratory failure, on aspects of pulmonary hypertension, treatment of hypoxic conditions, morphological basis of respiratory failure.