Vol 69, No 5 (1988)

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.

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.

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.

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.

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 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.

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.

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.

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.

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 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.

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.

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.

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.

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.

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.

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.

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.