Репозиторий Университета

© 2018, Dynasty Publishing House. All rights resvered. Abnormal uterine bleeding (AUB) is a collective term uniting various disorders of the menstrual cycle of structural and nonstructural genesis. The causes of AUB are united in the acronym PALM-COEIN (Polyp, Adenomyosis, Leiomyoma, Malignancy and hyperplasia, Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, Not otherwise classified). Not infrequently, AUB (PALM), especially in case of associated severe menstrual bleeding, is accompanied by the development of iron-deficiency anaemia (IDA), the basic pathogenetic therapy for which is administration of iron preparations (IP). The choice of an IP should be guided not by the total amount of iron compounds, but by the amounts of elemental iron. A medical practitioner has two groups of IP at his or her disposal – iron salts (IS) and iron-containing complexes (ICC). A comparative analysis of these groups of IP proves the effectiveness of ICC: absence of the impact of food and medication on absorption, slow absorption rate, rapid elimination from blood serum to reserves, absence of oxidative stress, a comparatively rare frequency of side effects on the part of the gastrointestinal tract. Since in female patients with AUB IDA is conditioned by continuing iron losses that exceed the amount of dietary iron intake, administration of IP is obligatory. Additionally, not only the effectiveness but also the safety of an iron-polymaltose complex should be taken into consideration. The good tolerance of Maltofer and a convenient schedule of its dosing ensure a high compliance of patients to therapy.

© 2018, Dynasty Publishing House. All rights reserved. The objective. Based on revealed changes in the parameters of the blood coagulation system and the functional state of the endothelium to propose pathogenetically justified therapeutic and diagnostic approaches ensuring a higher effectiveness of therapy of inflammatory bowel disease and prevention of complications. Patients and methods. We examined 78 children aged 3 to 15 years with newly diagnosed IBD, standard gastroenterological examination was performed to determine specificities of the coagulation system of IBD patients with administration of tests characterizing the state of all its components (number, size and aggregation of platelets, von Willebrand factor, international normalised ratio, activated partial thromboplastin time, thrombin time, fibrinogen, D-dimer, nitric oxide). Results. In the course of the study we found disorders in all components of the coagulation system. During exacerbation in children with ulcerative colitis and Crohn’s disease total concentrations of nitrates and nitrites in blood increase, in UC a reduced capability of the initial stage of thrombus formation with regard to the parameter «degree of platelet aggregation» can be found, which might account for frequent bleedings in this pathology. In CD, a significant decrease of platelet aggregation size was found, which is indicative of impaired functional properties of platelets. Investigating the coagulation component we found disorders of the final state of hemostasis – a prolonged time of fibrin clot formation resulting from prolonged TT, and also higher levels of D-Dimer, which is indicative of increased fibrinosysis processes. After alleviation of disease exacerbation the coagulation parameters only partially normalised: deviations in the platelet component remained. Conclusion. The processes of intestinal wall inflammation and disorders of the blood coagulation system in IBD exacerbation and in the course of its alleviation run parallel to each other. A developed clinical picture of IBD is accompanied by disorders of the initial (thrombus formation) and final (increased fibrinosysis) stages of blood clotting. A decreased degree and quality of platelet aggregation, increased fibrinosysis are evidently an important pathogenetic component of gastrointestinal bleeding.

© 2018 Stolichnaya Izdatelskaya Kompaniya. В последние годы наблюдается очевидная тенденция увеличения в популяции числа пожилых больных. Эти пациенты в большинстве случаев страдают несколькими коморбидными заболеваниями, что значительно утяжеляет прогноз и усложняет тактику ведения. Представлен клинический случай пожилой пациентки, длительное время страдающей сахарным диабетом 2 типа, получающей инсулинотерапию, нахо- дящейся на программном гемодиализе из-за терминальной хронической почечной недостаточности, а также имеющей постоянную форму фибрилляции предсердий. Пациентка была госпитализирована в ГКБ №1 им Н.И. Пирогова по поводу острого повторного инфаркта миокарда. Проведено экстренное чрескожное коронарное вмешательство, стентирование инфаркт-зависимой артерии стентом с лекарст- венным покрытием. Послеоперационный период осложнился развитием острой кровопотери на фоне кровотечения из верхних отделов желудочно-кишечного тракта, тяжелой анемии сочетанного генеза (постгеморрагической, нефрогенной), что потребовало от врачей принятия нестандартных решений по выбору антитромботической терапии. Данный клинический случай иллюстрирует сложности ведения пожилых полиморбидных пациентов в реальной клинической практике, и спорные вопросы, возникающие при назначении им антитромботической терапии, особенно, после развившегося кровотечения. Рекомендательные документы не могут дать ответ на все вопросы, которые ставит перед врачом повседневная практика. В каждом конкретном случае возобновление антитромботической терапии и ее оптимальный выбор для пожилого полиморбидного пациента с развившимся кровотечением является предметом дискуссии, и представляет для лечащего врача настоящий вызов.

© 2018 Vserossiiskoe Obshchestvo Kardiologov. All rights reserved. A literature review provided, on the usage of various schemes of perioperational anticoagulation therapy (ACT) in atrial fibrillation patients undergoing scheduled surgery. It is noted that clinicians quite often pass through a situation when patients taking ACT require invasive investigations and surgery. Perioperational management of such category of patients is complicated as, on the one hand, the surgery under ACT is associated with intraoperational hemorrhagic complications, and, on the other hand, ACT cessation might increase the risk of thrombotic complications. The variants assessed, of different periprocedural ACT in patients taking vitamin K antagonists. It was found that as an alternative to continuous ACT recently, bridge therapy with low molecular weight heparins applied, aiming the decrease of the risk of bleeding in adequate thromboprophylaxis. The results of clinical trials provided on the assessment of bridge therapy in surgery. Risk stratification approaches presents for thromboembolic and hemorrhagic complications in surgery.

© 2018 Ekaterina Vladimirovna Silina, Mukimdjon Ahmadzhonovich Sobirovz, Sergey Brankovich Bolevich and Aleksandrovich Stupin. The main aim of the study was to determine ways of improving the results of treating patients with ulcer bleeding of various nature and severity. It was provided by the system study of free radical processes and evaluation of the effectiveness of timely antioxidant therapy. Material and methods. The study included 153 patients aged 18-94 years with acute and chronic gastric and duodenal ulcers complicated by gastroduodenal bleeding. Patients were divided into two groups: group I (experimental group) included 62 patients who received antioxidative therapy with reamberin as a part of the basic therapy; and group II (control group) included 91 patients who received standard therapy. Various parameters of Free Radical Processes (FRP) were studied in dynamics in all patients. Results. We revealed the significance of oxidative stress on the first day of hospitalization in patients with gastrointestinal ulcerous bleeding of various character and severity. It was discovered mostly in severe patients with acute Gastroduodenal Ulcerous Bleeding (GDUB). In case of mild gastrointestinal ulcerous bleeding, oxidative stress disorders affected an oxygen stage of oxidative stress and represented themselves adaptive compensatory mechanisms. As the severity of the disease increased, intensification of an oxidant stress was manifested by a decrease in oxygen activity and an increase in lipid imbalance. Imbalance in free radical processes continued for a long time until discharge of patients from the hospital. The data obtained claimed to be the basis for recommendation to include antioxidant energy-conserving therapy in the complex of therapeutic measures in the earliest possible terms. We found out an efficacy of using succinic acid therapy with reamberin in patients with gastrointestinal bleeding. Positive effect of succinic acid on the markers of oxidative stress was confirmed by improvement in the disease pattern and success of the treatment.

© 2018 Media Sphera Publishing Group. All Rights Reserved. Aim - the objective of the present work was to analyze the data obtained in a study involving a group of patients presenting with recurrent deep vein thrombosis and/or bleeding who had been treated with the use of vitamin K antagonists. Material and methods. A total of 116 patients presenting either with recurrent deep vein thrombosis (n=10) or bleeding that developed while patients had been on the therapy with vitamin K antagonists were enrolled in the study. We performed clinical and instrumental examination as well as laboratory testing of the hemostatic system. All the patients received warfarin during 6 months or longer with 32 of them taking this medication to prevent deep vein thrombosis and the remaining 84 for the treatment of various cardiac diseases. The results of the clinical, instrumental, and laboratory studies provided a basis for the choice of the treatment strategies. Results. Sixty seven of the 116 patients were treated non-surgically while 27 patients were operated (25 urgently and two within 2 days after the admission to the hospital). 20 patients underwent endoscopic hemostasis, in two others the hematoma was punctured under ultrasound guidance. Eight patients presenting with recurrent deep vein thrombosis received the conservative treatment reduced to the correction of anticoagulation therapy (they were first switched from warfarin to heparins with the subsequent resumption of warfarin treatment using the individually adjusted doses of the drug). Two patients with free-floating thrombi in the main veins required the surgical intervention to prevent pulmonary embolism. The conservative treatment of the patients with bleedings included the withdrawal of warfarin together with the simultaneous administration of vitamin K1, fresh frozen plasma, and prothrombin complex concentrate in different combinations taking into consideration the results of clinical examination and laboratory testing. The conservative treatment was successful in all the cases. No severe complications, life-threatening conditions or death were documented. Conclusion. The patients receiving vitamin K antagonists are at enhanced risk of both a relapse of venous thromboembolism and bleedings. The timely started and appropriate management can prevent the severe complications.

© Bionika Media Ltd. Objective. To systematize the current medical knowledge and experience in the management of pregnancy and delivery in patients with mesenchymal dysplasias (Marfan syndrome, Ehlers-Danlos syndrome, Rendu-Osler syndrome). Material and methods. The paper includes the data of foreign investigations and medical guidelines for this problem, which have been published in the past 5 years. Results. The paper describes the molecular bases of each syndrome, diagnostic criteria, and their clinical manifestations in various organs and systems: musculoskeletal and cardiovascular systems, the organ of vision, etc. Such patients during pregnancy are at extremely high risk for life-threatening complications. Conclusion. A successful outcome of pregnancy requires early diagnosis and a multidisciplinary approach throughout during pregnancy and delivery.