[Endogenous heparin-like syndrome: analysis of clinical observations].

One of the reasons for non-surgical bleeding is heparin-like syndrome (HLS), under which is understanded presence of heparin effect in the absence of it's exogenous application. The role of endogenous heparins perform glycosaminoglycans -- biologically active substances. HLS is accompanied by endothelium damage and discussed in the network of the systemic inflammatory response syndrome (SIRS). HLS is described in liver future, sepsis, pregnancy and a number of hemoblastosis. Hypocoagulation effect of endogenous heparin localizates in X coagulation factor. The main method of diagnosis - thromboelastography. The use of a specific heparin antidote - Protamine sulfate has not confirmed clinical efficacy. Priority direction in the therapy of - methods of "shunt hemostasis". In this paper, we present the analysis of observations of 4 patients with developed endogenous HLS. In 2 cases (combination of sepsis with hepatic failure in one patient and initial thrombophilia in other) HLS has been accompanied by massive bleeding (massive hemothoraxc with haemorrhagic shock, a massive intraoperative blood loss). For HLS relief in these cases was used prothrombine complex concentrate (PCC) (in the 1st case), recombinant VIIa factor (in the 2nd case). In other cases, HLS (in a patient with multiple myeloma and childbirth in the postpartum period), haemorrhagic syndrome was not so expressed, the treatment was carried out with FFP transfusion.

[Therapy of acute massive blood loss in a hemophilic patient: case report].

A case is reported of management of massive intraoperative blood loss in a male patient with severe hemophilia. Extirpation of hip pseudotumor with one-stage osteosynthesis with an intramedullary joint-pin in a 43 year old male patient was accompanied with 7.5 l blood loss. The infusion-transfusion therapy (ITT) contained transfusion media about 1/3 of the total volume, fresh-frozen plasma and erythrocyte-containing media were used 1:1. Infusion solutions consisted of balanced polyelectrolytic solutions, hydroxyethylated starches 130/0.4, hyperchaes. Intraoperative normovolemic hemodilution and reinfusion of wound blood were made (CellSaver). ITT target markers were standard hemodynamics control tests. Hemostasis monitoring was conducted with thromboelastography. Complex ITT based on modern principles of clinical transfusiology provided a complete and safe compensation of massive intraoperative blood loss in a patient with severe hemophilia.

[Renal monoclonal immunoglobuline deposition disease as a rare variant of renal damage in multiple myeloma].

A case of the immunoglobuline deposit disease diagnosis in MM patient having the symptoms of intensive proteinuria, macrohematuria and terminal renal failure is reported. The disease was diagnosed by the evidence from electron microscopy of the kidney and liver biopsies.

[Artificial lung ventilation using separate intubation of two main bronchi in patients with acute respiratory failure].

Two-luminal endotracheal tubes are used for one-lung or selective ventilation. However, in some cases there is a need for not only to isolate the lung, but also to exclude the trachea from ventilation, for example, in injuries of its distal portions. The use of a two-luminal endobronchial tube under these conditions does not always permit isolation of an affected area since the tracheal cuff is frequently above the site of an injury. For the treatment of such complications and for selective ventilation, it is proposed to use separate intubation of two main bronchi under guidance of fibrobronchoscopy. For this, two single-luminal bronchial tubes having different inlet openings are simultaneously used; one tube is inserted translaryngeally, the other is placed through the tracheostomic opening. The tube having a cut in the bronchial cuff with an opening for ventilation of the right upper lobar bronchus is employed for the right main bronchus. There are examples how to use separate intubation of the main bronchi in patients with acute respiratory failure. This procedure may be the method of choice for treating tracheal distal injuries and, if required, for performing selective artificial ventilation. The effects of the latter are analyzed.