Репозиторий Университета

© 2019, Springer Science+Business Media, LLC, part of Springer Nature. A model of moderate hyperhomocysteinemia associated with mechanical injury of the musculoskeletal system was developed and experimentally substantiated. The adequacy of this model for studies of morphological and functional regularities is verified. This model can be used for the development of a new concept of evaluation of thrombotic complications of mechanical injury.

© 2018, Pediatria Ltd.. All rights reserved. Objective of the research: to define peculiarities of Kawasaki syndrome (KS) course in patients with giant coronary artery aneurysms (GCAA) to assess risk factors for complicated course, frequency, development time, the dynamics of coronary thrombosis and stenosis, and to rationale for the examination and treatment of convalescents. Materials and methods: in 2003–2017 342 children with KS were examined, GCAA was found in 17. Results: in all patients with GCAA KS treatment was started untimely (on the 12th–60th day of the KS). Thrombi in GCAA were found in 14, coronary arteries stenosis (CA) – in 6 patients. Thrombi regressed in 7, decreased – in 2, occlusion of right CA – in 2. Myocardial infarction was in one patient. Surgical treatment was in 5 patients: 3 – mammaroconary shunting (MSC), 2 – CA stenting, in one of them after 10 months – stent occlusion, MCS. Conclusion: to reduce the risk of life-threatening complications, timely treatment of KS, assessment of CA lesions nature for adequate thrombosis prophylaxis, detection of significant CA stenosis, timely consultation with cardiac surgeon are necessary.

© 2018 Vitebsk State Medical University. All rights reserved. The acute mesenteric ischemia is one of the most complex problems in the urgent surgery because of the high mortality, the cause of which is late diagnosis. The operation treatment is often provided in the phase of diffuse peritonitis. This literature review is done in order to identify the most accessible and accurate methods of early diagnosis of the acute mesenteric ischemia. At present time rather a small number of biomarkers for diagnosing the acute mesenteric ischemia are used, such as α-glutamate-S-transferase, D-dimers, procalcitonin, D-lactate, intestinal fatty acid binding protein (I-FABP), ischemia-modified albumin. According to the literature the highest sensitivity and specificity were found in I-FABP (75-85% and 70-80% respectively), α-glutamate-S-transferase (67.8% and 84.2%), ischemia-modified albumin (94.7% and 86.4%). In addition, expensive and invasive methods are currently used for early diagnosis, such as CT angiography, contrast-enhanced MRI, selective angiography. However, these technologies are not available to all medical institutions. We should continue further search of various biomarkers and their more widespread introduction to clinical practice in order to solve the problem of early acute mesenteric ischemia diagnostics.

© 2018 Stolichnaya Izdatelskaya Kompaniya. The article presents a clinical observation of the left atrial appendage thrombosis in a 51-year-old female patient with a paroxysmal form of nonvalvular atrial fibrillation which occurred despite long-term anticoagulant therapy with apixaban in a full dose (5 mg b.i.d.), and the patient's management. The patient was admitted with recurrent symptomatic paroxysm for more than 48 hours, because of which, in accordance with the recommendations, transesophageal echocardiography was performed before an emergency rhythm restoration. Thrombus in the left atrial appendage 0.5×1.03 cm in size was detected. It was decided to refrain from the immediate restoration of the rhythm due to the very high risk of thromboembolic complications. In connection with the categorical refusal of the patient from warfarin, it was decided to replace apixaban with another direct oral anticoagulant - dabigatran 150 mg bid for a period of 4 weeks followed by performing a control transesophageal echocardiographic study. As a result, no thrombus was found on control echocardiography. The particularity of this observation is concomitant hypertrophic cardiomyopathy and diabetes mellitus type 1 in this patient..

© Bionika Media Ltd. Objective. To carry out a systematic analysis of the data available in the current literature on the modern view on Trousseau’s syndrome Material and methods. The review included the data of foreign and Russian articles published in the past 10 years and found in e-Library and PubMed on this topic. Results. This paper provides a pathogenetic explanation for the increased thrombotic potential in cancer patients, which underlies tumor growth and metastasis. In addition to direct thrombotic events, the paper also describes hemorrhagic complications resulting from systemic coagulopathy, including disseminated intravascular coagulation, hemolytic thrombotic microangiopathy, and excessive fibrinolysis. Conclusion. At present, any manifestation of thrombohemorrhagic complications in patients with malignant tumors can be classified as a paraneoplastic syndrome (Trousseau’s syndrome). In addition to Virchow’s classic triad, hyperproduction of tissue factor (TF), the main initiator of the extrinsic coagulation pathway, underlies the pathophysiology of Trousseau’s syndrome. At the same time, the substantial release of microparticles from TF-bearing tumor cells is critical not only for clot formation, but also for the progression of tumor growth.

© 2018 Ima-Press Publishing House. All rights reserved. Objective: to determine risk factors (RFs) for venous thromboembolic events (VTE) in patients with rheumatoid arthritis (RA). Subjects and methods: The investigation enrolled 374 patients (311 women and 63 men) with a reliable diagnosis of RA who met the 2010 ACR/EULAR classification criteria. The patients' mean age was 53.7±13.6 years; the disease duration was 12.1±10.7 years. All the patients were treated at the V.A. Nasonova Research Institute of Rheumatology Clinic during the period from 2014 to 2017. A standard clinical examination of the peripheral joints was performed. RA activity was measured using DAS28. A survey was made using a questionnaire including questions on traditional RFs for VTE and RFs that might be caused by RA and its therapy. Results and discussion. VTE were recorded in 45 (12%) out of the 374 patients. Group 1 included 45 patients with VTE; Group 2 consisted of 329 patients without VTE. Multidimensional analysis showed an increased risk of developing VTE in RA under the influence of the following factors: high inflammatory activity; lower extremity varicose veins; hypercholesterolemia; and hypertension. Their weighted coefficients were 1.1, 2.5, 1.0, and 0.9, respectively. According to the obtained model (p<0.001), the risk of VTE in RA can be predicted by the following formula: Z = 1.1 • high RA activity (Yes = 1/No = 0) + 2.5 • lower extremity varicose veins (Yes = 1/No = 0) + + 1.0 • hypercholesterolemia (Yes = 1/No = 0) + 0.9 • hypertension (Yes = 1 / No = 0). Conclusion: The increased risk for VTE in RA patients determines the need for its timely assessment, by taking into account the known risk factors as both standard ones and those caused by the disease itself and its therapy. This risk assessment is necessary for the timely adequate treatment and prevention of thrombotic events in RA.

© 2018, Dynasty Publishing House. The assessment of thrombosis and bleeding risks is one of the most important tasks of laboratory diagnostics of disorders in the hemostasis system. For this purpose the highly specialized tests are not always appropriate, because these assays are focused on specific markers or pathologies of individual links: the level of coagulation factors, the level of D-dimers, ADP- and serotonininduced platelet activation, effects of acetyl salicylic acid on aggregation. Nowadays, integral assays are the most promising approach, simulating hemostatic process in vivo - thromboelastography, thrombodynamics, thrombin generation. These tests are designed to specify the risk of thrombosis or bleeding with co-origin, as well as screening and monitoring of drug therapy. One of the approaches in the development of integral assays are flow systems where plasma or whole blood flow is formed over the hemostatic activator, and the growth of the thrombus is recorded on the video. There are commercially available samples of such devices, and some experience of its application in clinic. However, there are no uniform standards and clinical guidelines. This review describes examples of flow chambers exploitation for diagnosis, existing problems of its usage and the opportunities that it can provide to the clinicians.