[Contemporary data on efficacy of anticoagulant therapy in recanalization of deep veins]. / Sovremennye dannye ob éffektivnosti antikoaguliantnoi terapii pri rekanalizatsii glubokikh ven.

The article is a literature review containing a detailed description of anticoagulant therapy variants, their efficacy in recanalization of deep veins, as well as patients' compliance to treatment. Russian specialists have demonstrated that the processes of active re-organization of thrombotic masses, in some cases leading to complete clearing of the vessel's lumen from a thrombus, may be observed at terms from 3 to 6 months, with a failure to occur within the above period reportedly followed by formation of irreversible cicatricial-sclerotic alterations in the veins. That is why adequate anticoagulant therapy should be initiated promptly in order to prevent the development of irreversible alterations and a decompensated form of chronic venous insufficiency. The process of recanalization of the venous segments involved appears to primarily depend on efficacy of anticoagulant therapy. Of special attention is a class of novel oral anticoagulants characterised by high clinical efficacy, prolonged and relatively safe administration, as well as thrombolytic activity. The use of anticoagulant therapy, as well as adherence of patients to treatment make it possible to significantly decrease the frequency of a decompensated form of venous insufficiency and the need for reconstruction of the major veins.

[Experience in treating portal thromboses in patients with chronic myeloproliferative diseases].

Patients with myeloproliferative diseases (MPD) are noted to be at high risk for portal thromboses. This problem gives rise to disability if it is untimely treated or resistant to therapy. The paper gives the experience of the Outpatient Department of the Hematology Research Center, Ministry of Health of the Russian Federation, in using antithrombin III in MPD patients (3 patients with primary myelofibrosis, 3 with essential thrombocythemia) and acute and subacute portal vein thromboses resistant to therapy with direct anticoagulants. In all 5 cases, the use of antithrombin III in combination with low-molecular-weight heparin showed a positive clinical effect as rapid relief of pain syndrome and comparatively early (3-week to 1.5-2-month) recanalization of thrombosed vessels. Three clinical cases are described in detail.

[The combined rehabilitative treatment of the children with obesity and metabolic syndrome].

The present study included a total of 66 children at the age from 11 to 16 years with obesity and metabolic syndrome. The latter condition in the childhood and adolescence is characterized by the pronounced disturbances of basal metabolism, vasoactive systems, psychoemotional status, and regulatory hormonal functions that determine the choice of rehabilitative modalities. The combined treatment of such disturbances is considered to be an efficacious method for the rehabilitation of these patients. It is recommended that cortexin be prescribed to the children presenting with obesity and metabolic syndrome because this medication promotes correction of the hormonal and metabolic status and improves the brain cognitive function.

[Acute abdominal syndrome in blood system diseases].

AIM: To define an optimal diagnostic and therapeutic algorithm when the acute abdominal syndrome occurs in hematological patients. MATERIALS AND METHODS: The results of 145 emergency surgeries made in 2006-2008 for acute abdominal syndrome were studied in patients with blood system diseases. RESULTS: Clinical manifestations of acute abdominal syndrome emerge in 1-1.4% of all the patients treated at the Hematology Research Center, Russian Academy of Medical Sciences. There is a need for surgery in 0.5-0.7% of all the patients admitted. In this group of patients, annual postoperative mortality is 12-16%. CONCLUSION: The routine algorithm for a diagnostic search in hematological patients with acute abdominal syndrome can lead to both hyperdiagnosis and unwarranted surgery, and incorrect choice of expectant policy as well.

[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.

[Hyperhomocysteinemia--one of the factors underlying thrombotic complications in patients with chronic myeloproliferative diseases].

AIM: To assess incidence of hyperhomocysteinemia (HHC) in patients with chronic myeloproliferative diseases (CMPD) and to analyse possible correlation between an elevated concentration of plasma homocystein (HC) and thrombotic complications. MATERIAL AND METHODS: The trial enrolled 61 patients: 39 CMPD patients with thrombotic complications and free of them, 22 nonhematological patients with thrombosis. The control group consisted of 40 healthy donors. The examination protocol included determination with standard methods of HC plasma concentration, platelet and plasma components of hemostasis, mutation of factor V Leiden gene, prothrombin and methylenetetrahydrofolate reductase (MTHFR). RESULTS: Mean HC concentration in the serum in CMPD patients was 19 +/- 1.7 mcmol/l which appeared higher than in healthy donors (12 +/- 1.3 mcmol/l). The highest HC was in patients with subleukemic myelosis (SLM)--23 +/- 2.3 mcmol). No difference in HC concentration in plasma was observed in CMPD carriers of homo- or heteroxygous mutation of C667T gene or CMPD patients without the mutation. In CMPD content of factor VIII was higher in HHC than in normal HC (222 +/- 26.5 and 116 +/- 20%, respectively, p = 0.002). For von Willebrand factor 202 +/- 15.6 and 120 +/- 14.6%, respectively (p < 0.003). HC reduction in response to vitamin therapy was the greater the higher its initial level was. CONCLUSION: There is correlation between HHC and thrombosis in CMPD patients. HC concentration may depend on the proliferative stage of CMPD. As HC is a significant independent factor of thrombotic complications risk, it is necessary to detect and treat HHC.

[Enzymes of purine metabolism of lymphocytes and eosinophiles in bronchial asthma]. / Fermenty purinovogo obmena limfotsitov i éozinofilov pri bronkhial'noi astme.

The activity of the enzyme purine metabolism (5'-nucleotidase, adenosine deaminase, xanthine oxidase and the content of uric acid, i.e. the final product of the purine metabolism) were determined in lymphocytes, eosinophiles and blood serum of patients with bronchial asthma. The activity of 5'-nucleotidase in lymphocytes, eosinophiles and blood serum of patients with bronchial asthma was found to be reduced by 5-7-% as compared with the controls. The activity of adenosine deaminase in lymphocytes, eosinophiles and blood serum was found to be reduced in a majority of patients. An increased activity of adenosine deaminase was higher in lymphocytes and blood serum of 38% of the examined patients. The activity of xanthine oxidase in lymphocytes and eosinophiles of patients exceeded by 2.4 and 1.7 times the control value, respectively. The content of urine acid was found to be increased, in bronchial asthma, by 2.7 times. Consequently, the balance of enzyme reactions of the purine metabolism is impaired in bronchial asthma, and there is an accumulation of urine acid.

[Indices of proteolysis in evaluation of resorption in bone tumors]. / Pokazateli proteoliza v otsenke rezorbtsii pri opukholiakh kosti.

Activities of acid and alkaline phosphatases, collagenase, cathepsin D, trypsin-like proteinases, alpha(1)-proteinase inhibitor (alpha(1)-PI), alpha(2)-macroglobulin (alpha(2)-MG) were measured in blood plasma and tumor tissue of patients with giant-cell tumor of the bone (GCTB) and bone chondrosarcoma. These tumors differed by enzymatic activities. GCTB is characterized by increased activity of alkaline phosphatase, while in chondrosarcoma tissue the activities of collagenase and cathepsin D were the highest. Activities of acid phosphatase, collagenase, trypsin-like proteinases were increased in the plasma of patients with both tumors; alpha(1)-PI/alpha(2)-MG ratio was increased. Bone resorption parameters correlated with proteolysis inhibitors. Activities of collagenase and acid phosphatase were increased in tumor tissue and plasma in the presence of low activities of alpha(2)-MG and increased alpha(1)-PI/alpha(2)-MG index, which seems to require special attention during the postoperative period.

[The activity of trypsin and proteolytic inhibitors in complicated forms of appendicitis in children]. / Aktivnost' tripsina i ingibitorov proteoliza pri oslozhnennykh formakh appenditsita u detei.

The activity of trypsin, alpha 1-proteinase inhibitor, and alpha 2-macroglobulin (MG) was measured in the blood plasma of patients with destructive appendicitis and localized and generalized peritonitis during admission to hospital and for 3 weeks after surgery. A deficit of MG was found in all forms of these diseases. A decreased activity of MG in the blood plasma is apparently a risk factor for emergency inflammatory diseases of abdominal organs. After appendectomy a more demonstrative index of patient's status is trypsin activity, an increase of which is most of all expressed in generalized peritonitis. Quantitative assessment of the trypsin-inhibitor system activity before and after surgery is necessary for a more accurate diagnosis and for monitoring the quality of treatment.

[The clinical significance of a combination of dysplastic scoliosis with hemostatic system disorders]. / Klinicheskoe znachenie sochetaniia displasticheskogo skolioza s narusheniiami sistemy gemostaza.

Examined were 74 patients ranging in age from 6 to 48 years with dysplastic scoliosis. Disorders in the system of hemostasis were revealed in 67 patients. Including the 25 operated ones. The operative blood loss of more than 20 % of the circulating blood volume was noted 2 times more often in patients with the disorders in the system of hemostasis, mainly with the VIII factor deficiency. Intravenous administration of a cryoprecipitate contributed to restoration of the normal VIII factor level and more than 2-fold decrease in operative blood loss.

[Disorders of the hemostasis system in patients with mitral valve prolapse]. / Narusheniia sistemy gemostaza u bol'nykh s prolabirovaniem mitral'nogo klapana.

Mitral prolapse is frequently encountered in association with other manifestations of mesenchymal dysplasia (skin hyperelastosis, joint hypermobility, dislocations, etc.) and occasional bleedings. Of 35 cases reported, 17 had petechiae and ecchymoses, 1 had hematuria, the rest suffered from bleedings: nasal (22 cases), profuse menstrual (19 cases), long-term extraction and cut bleedings (9 cases), gastrointestinal (3 cases). Hemorrhages of different sites often occurred in combination. Hemostatic investigations revealed: platelet aggregation dysfunction, Willebrand syndrome, end coagulation disturbances, lack or anomalies of factors VII, X and II (14, 17, 12 and 4 patients, respectively).

[Disturbances of hemostasis and the genesis of hemorrhagic diathesis in patients with dysplastic scoliosis]. / Narusheniia sistemy gemostaza i genez krovotochivosti u bol'nykh s displasticheskim skoliozom.

Dysplastic scoliosis often occurs with parallel hemostasis disorders and is fraught with the risk of intra- or postoperative risk of hemorrhagic complications. For early correction of hemostasis and adequate management of the patients, hemostasis parameters should be found out. Administration of indirect-action anticoagulants is risky. The use of heparin or fraxiparin is more valid. The latter of them maintains the threat of postoperative hemorrhage onset in the least degree.

[Activity of 5'-nucleotidase from thymus and tumors upon administering bradykinin to tumor-bearing mice]. / Aktivnost' 5'-nukleotidazy timusa i opukholi pri vvedenii bradikinina mysham-opukholenositeliam.

Activity of 5'-nucleotidase was inhibited in thymus tissue of tumor-bearing mice; bradykinin (1 mg/kg body weight) increased the enzymatic activity 2.0-2.2-fold. Administration of bradykinin led to inhibition of allogenic Crocker's sarcoma growth and to stimulation of syngeneic mastocytoma P-815 growth, which was inoculated into noninbred and BALB/c mice, respectively. Hence, bradykinin activated 5'-nucleotidase in Crocker's sarcoma and did not affect the enzymatic activity in tumor P-815. This suggests that activity of 5'-nucleotidase is of importance in evaluation of the thymus tissue state as well as it demonstrates the tumoral tissue sensitivity to bradykinin.

[Modification with bradykinin of membrane-bound lipid peroxidation and Ca2+-activity of the thymus and liver]. / Modifikatsiia bradikininom memnranosviazannykh protsessov perekisnogo okisleniia lipidov i aktivnosti Ca2+-ATFazy timusa i pecheni.

Effect of bradykinin on activity of Ca2+-ATPase and accumulation of malonic dialdehyde (MDA) was studied in proliferating and relatively non-proliferating (resting) cells of thymus and liver tissues. The peptide effect was studied in vivo and in vitro after intravenous administration into mice at a dose of 2 mg/kg or by means of addition of bradykinin (10(-6)M) to a suspension of calf thymocyte membranes. In vivo bradykinin caused the most distinct decrease in MDA accumulation and activation of Ca2+-ATPase in thymus as compared with liver tissue. In vitro incubation of thymocyte membranes with bradykinin led to prolongation of the latent period of MDA formation and to a distinct increase in the Ca2+-ATPase activity. Modification of these processes in membranes appear to be one of important functions of bradykinin in proliferation.