Wound analgesia in a patient with hemophilia in a highly traumatic operation.

AIM: The aim of the study was to describe the use of the wound analgesia method in a patient with hemophilia in the case of a clinical case. MATERIALS AND METHODS: A patient with severe hemophilia A underwent postoperative analgesia after total knee replacement (within the first 48 hours) with an extended infusion of local anesthetic (ropivacaine) into the wound. RESULTS: During the first 8 hours, the patient received 20 mg of morphine (with the aid of a device for patient-controlled analgesia), the pain level ranged from 7 to 4 points. Further, there was a sufficient effect (NRS - 2 points), from anesthesia only with ropivacaine, using a system for anesthetizing surgical wounds. Complications and side effects were not noted. CONCLUSION: The clinical case demonstrates an effective and safe method of prolonged analgesia in patients with hemophilia. Considering encouraging data, further study of wound analgesia in this category of patients is necessary.

[The laboratory diagnostic of herpes viral infections under nosocomial pneumonia in oncologic hematologic patients].

The study was organized to discover diagnostically valuable clinical material for detection of etiologic agent of pneumonia in oncological hematological patients, rate of association of nosocomial pneumonia with herpes viruses and evaluation of viral load in patients with depressed immunity. In oncological hematological patients, half of nosocomial pneumonia cases is associated with herpes virus. In every third patient DNA of Epstein-Barr virus and DNA of type I and II are detected. The most informative material in this case is broncho-alveolar lavage fluid and the most convenient diagnostic technique is polymerase chain reaction in real-time. The low viral load in broncho-alveolar lavage fluid is specfic for Epstein-Barr virus, cytomegalovirus and human herpes virus type VI. The concentration of DNA ofsimple herpes virus type I and type II is located in both high and low values. The paradox phenomena is established concerning more benevolent course of nosocomial pneumonia associated with simple herpes virus type I and II in patients with higher viral load in broncho-alveolar lavage fluid. The further research in this direction is needed.

[Treating patients with acute myeloid leukemias (AML) according to the protocol of the AML-01.10 Russian multicenter randomized trial: the coordinating center's results].

AIM: To make a randomized comparison of 2 consolidation treatment options (two patient groups): 2 cycles of cytarabine in average (Ig/m2 in Group 2) and standard (100 mg/mi2 in Group 1) doses in combination with idarubicin (8-12 mg/m2) and mitoxantrone (10 mg/m2), after two 7+3 induction cycles of daunorubicin (60 mg/mi2) and subsequent 6 cycles of maintenance therapy. SUBJECTS AND METHODS: In January 2010 to October 2013, a Russian multicenter trial was conducted to treat patients with acute myeloid leukemias (AML) in accordance with the AML-01.10 protocol (ClinicalTrials.gov Identifier: NCT01587430). The trial enrolled 243 AML patients from 21 centers, including 71 patients (median age 38 years) from the State Hematology Center, Ministry of Health of the Russian Federation; 35 and 36 patients were randomized to Groups 1 and 2, respectively. The randomized groups were balanced by basic clinical and laboratory parameters. Favorable, intermediate, and high cytogenetic prognoses were in 14 (21.9%), 40 (62.5%), and 10 (15.6%) patients, respectively. RESULTS: Prior to treatment, 2 patients died; one patient refused treatment. Fifty-eight (85.3%) of the 68 patients achieved complete remission (CR); early deaths was in 2 (2.9%) and resistance in 8 (11.8%). Four (6.9%) patients died during CR. Protocol deviations (doses, intervals, and the number of cycles) were recorded in 12 (20.7%) of the 58 patients. Other 8 (11.8%) patients were switched to low-dose cytarabine because of complications, withdrawn from the protocol and not included into the analysis of randomized comparison. Twenty allogeneic bone marrow transplantations (allo-BMT) (7 related, 12 unrelated, and 1 haploidentical) were performed; of them 15 allo-BMTs were done during first CR. In the 68 patients, 3-year overall survival (OS) was 45.6%; relapse-free survival (RFS) was 41.5%. OS was 64.6% in Group 1 and 58.3% in Group 2; RFS was 62 and 38.8% in Groups 1 and 2, respectively (p>0.5). In the favorable, intermediate, and high prognosis groups, OS was 79.5, 60, and 31.1% and RFS was 81.8, 41.3, and 33.3%, respectively (p=0.1). The consolidation treatment option unchanged survival rates in the above risk groups. Unachieved CR after the first cycle considerably decreased RFS (33.9% versus 60%) and served as an indication for allo-BMT during first CP (RFS without BMT was 0; that with BMT was 78%). CONCLUSION: No differences were found between both consolidation options according to long-term results. Protocol deviations were recorded in one-third of the patients. While implementing the protocol, the efficiency of treatment was high. Allo-BMT during first CR substantially increased RFS if CP was not achieved after the first cycle.

[Whether fibrinogen concentrates are necessary in Russia?].

PURPOSE OF THE STUDY: To analyze an efficiency of hypofibrinogenemia treatment. In the Scientific Center for Hematology (Moscow) significant hypofibrinogenemia occurs in 3% of patients with hemoblastosis. 1000 doses of cryoprecipitate are used for a hypofibrinogenemia treatment every year (21-23 doses for each patient). Containing of fibrinogen in a one cryoprecipitate dose is from 108 mug to 711 mug (M = 276 mug). Volume of one dose is from 8 to 90 ml (M = 24 ml). Hypofibrinogenemia occurred in all patients required a cryoprecipitate transfusion (M = 1 g L(-1), min 0.5 g L(-1), max 2 g L(-1)). We fixed an increasing of fibrinogen level in plasma by 0.7 +/- 0.2 g L(-1) after the cryoprecipitate transfusion. We analyzed a world experience of the use of fibrinogen containing blood components. CONCLUSIONS: Fresh frozen plasma transfusion cannot be a choice method of treatment for hypofibrinogenemia. Fibrinogen's concentrate has the same effectiveness as a cryoprecipitate both for congenital and acquired deficit of fibrinogen. The frequency of complications due to fibrinogen's concentrate is low. Currently clinical studies of recombinant fibrinogen are conducted. Ways of implementation of fibrinogen preparations in Russia are discussed.

[The particularities of acute surgical diseases treatment of abdominal cavity organs in patients with haemophilia].

The experience of treatment of 366 patients with haemophilia who were urgently hospitalized in hеmatological Scientific Center over the last 10 years is presented in the article. There were 114 (31.1%) patients with acute diseases of abdominal cavity organs, 150 (41%) patients with bleeding from upper gastrointestinal tract, 102 (27.9%) patients with acute hematomas of retroperitoneal space. Urgent operations were performed in 48 (22.2%) patients who were hospitalized with clinical symptoms of acute abdomen syndrome. It was developed the criteria of diagnosis and choice of treatment tactic on the basis of the received results. Application of presented algorithms led to improve the quality of urgent surgical care to patients with haemophilia.

[Clinical manifestations of Legionella pneumonia in hematology patients].

AIM: To detect the most common clinical manifestations of Legionella pneumonia (LP) in immunocompromized patients. SUBJECTS AND METHODS: Clinical manifestations, the results of investigation of bronchoalveolar lavage fluid (BALF) and urine, and the data of lung computed tomography (CT) were studied in patients with blood system diseases and acute respiratory failure (ARF). RESULTS: The diagnosis of LP was verified in 8 (10.5%) of 76 patients with blood system diseases and ARF. The disease manifested as fever, higher concentrations of inflammatory markers (procalcitonin, fibrinogen), ARF, hypoxemia, and infiltrative lung injury. Six of the 8 patients were switched to mechanical ventilation. Lung CT showed no pathognomonic signs. Five of the 8 patients were observed to have renal dysfunction. The diagnosis of LP was made on the basis of the results of BALF examination in 7 patients and urinary antigen detection in 1. The disease was caused by Legionella pneumophila serogroup 1 in 3 patients and by L. pneumophila of other serogroups in the other patients. Therapy with respiratory fluoroquinolones was performed in 5 patients. Three patients died from progressive ARF and hypoxemia. BALF results were obtained after their death and therapy for legionellosis was not initiated. CONCLUSION: The incidence of LP is 10.5% in hematology patients. The clinical manifestations of legionellosis are nonspecific; its diagnosis requires bacteriological and/or serological evidence. Due to the high risk of death, it is reasonable to preuse respiratory fluoroquinolones or macrolides in immunocompromized patients with progressive ARF and suspected Legionella pneumonia before diagnosis.

[Therapy with high-doses of antithrombin III in patients with septic shock and agranulocytosis].

OBJECTIVE: The aim of the study was to assess efficacy of high-doses ofantithrombin 111 (AT) for treatment of septic shock in patients with an agranulocytosis. DESIGN: Prospective, controlled study. PATIENTS: 29 patients from 18 to 74 years old, with blood diseases complicated with septic shock Dates of study: from 2006 to 2012. METHODS: The patients were randomized into two groups. Group-1 included 14 patients, who did not receive AT and group-2 included 15 patients who received AT. RESULTS: Demographic indicators, condition severity according to APACHE II, level of thrombocytopenia, levels ofplasma procalcitonin, interleukin-6 (IL-6) and C-reactive protein (CRP) were the same in both groups. Level of AT was decreased in both groups; however it was higher in the group-1 (50% vs. 60%, p < 0.05). In the group-1, microorganisms were found in the blood of 9 patients. In the group-2, the microorganisms were found in the blood of 11 patients. Inflammation markers were decreased after the treatment of septic shock in both groups (p<0.05). The decreasing of procalcitonin in group-1 was from 43.8 to 1 ng/ml in 14 days and from 12.8 to 1.6 ng/ml in 7 days in group-2. The decreasing of CRP in group-1 was from 224 to 114 mg/l in 7 days and from 146 to 60 mg/l in 14 days in group-2. The decreasing of IL-6 in group-1 was from 1617 to 100 pg/ml in 3 days and from 5895 to 77 pg/ml in 7 days in group-2. A level of AT was increased only in group-2 (under 12% per day). 28-day survival was higher in group-2 (60 +/- 13% vs. 45 +/- 13%, p<0.05). We did not find any complications of the treatment with AT concentrate. CONCLUSION: Treatment of septic shock with high-doses of antithrombin III was effective and safe in patients with an agranulocytosis.

[Using recombinant activated blood coagulation factor VII for treatment of hemorrhagic syndrome in patients with thrombocytopenia].

The review deals with an analysis of the use of recombinant activated factor clotting VII (rFVIIa) for the treatment of hemorrhagic syndrome in patients with thrombocytopenia. The review discusses cases of rFVIIa use during bleeding of different localization and different invasive interventions, a frequency of thrombotic complications and causes of the rFVlIIa insufficiency.

[Treatment of adult patients with acute promyelocytic leukemia according to the AIDA protocol].

AIM: To give the results of an investigation conducted at the Hematology Research Center (HRC), Ministry of Health of the Russian Federation (MHRF), to treat adult patients with acute promyelocytic leukemia (APL) according to the AIDA protocol elaborated by Spanish investigators. SUBJECTS AND METHODS: The investigation enrolled 33 patients diagnosed with APL verified by cytogenetic and molecular studies, who had been treated at the HRC, MHRF, in July 2009 to January 2012. The patients classified in the low-, intermediate-, and high-risk groups were 30, 46.7; and 23.3%, respectively. The analysis was made in January 2013. RESULTS: The number of patients who achieved complete remission, as well as the mortality rates during remission induction were wholly comparable to those previously obtained when using the 7+3+ATRA protocol: 90.3 and 9.7%, respectively. One patient in remission died (3.6% mortality rate). The likelihood of recurrence in this investigation was high (21%), which was due to gross noncompliance with maintenance therapy. On examining the clearance of the malignant clone by FISH and polymerase chain reaction, a naturally chimeric transcript identified by a molecular study was statistically significantly more frequently revealed during postinduction therapy, which was associated with different sensitivity of the techniques. Comparison of changes in the disappearance of a chimeric marker for APL with the AIDA and 7+3+ARTA programs showed that the clearance of the malignant clone was much slower. CONCLUSION: The AIDA program is a highly effective treatment protocol for patients with APL.

[Lung artery catheterization in patients with blood diseases].

UNLABELLED: Purpose of the study was to analyze complications of the lung artery catheterization in patients with blood disease. MATERIALS AND METHODS: 93 cases of the lung artery catheterization in patients with blood disease were studied in the retrospective research. RESULTS: Indications for lung artery catheterization were septic shock (in 78.5% of cases) and acute respiratory failure with different etiology (in 21.5% of cases). In 31 cases (33.3%) lung artery catheterization was performed in patients with agranulocytosis and in 81 cases (87%) in patients with thrombocytopenia (platelets median was 44 10(9)/L, from 7 10(9)/L to 7 150 10(9)/L). If a thrombocytopenia was less than 30 10(9)/L the patients received transfusion of platelets concentrates. Early complications of the lung artery catheterization occurred in 5 patients with thrombocytopenia (5.4%). Character of the complications was hemorrhagic (haematoma, bleeding from place of puncture, lung bleeding) and mechanical (puncture of artery, pneumothorax, haemothorax). Number of attempts of central veins puncture was a risk factor for the complications. Frequency of catheter associated sepsis was 5.89 cases each 1000 catheter-days. Frequency of soft tissues infection in the area of catheterization was 9.78 cases each 1000 catheter-days. Catheter associated infections occurred in cases when catheter was used more than 5 days. 2 of 3 patients with catheter associated sepsis had agranulocytosis. Other complications included intermittent arrhythmias during catheter moving through heart chambers (58), rupture of catheter container during its use (4), thrombosis of the one lumen of catheter (3). CONCLUSIONS: Lung artery catheterization can be used in patients with blood disease and first of all in patients with septic shock and acute respiratory failure. In patients with agranulocytosis less invasive methods of monitoring are more advisable.

[Treatment for acute promyelocytic leukemia during pregnancy].

AIM: To study the experience in managing patients with acute promyelocytic leukemia (APL) diagnosed in different periods of pregnancy. SUBJECTS AND METHODS: Nine women with APL were treated in 1998-2013. When APL was diagnosed in the first trimester of pregnancy, the latter was terminated (n = 1); when its diagnosis was made in the second trimester, chemotherapy (CT) followed by delivery (D) was performed (n = 3); when it was done in the third trimester, D followed by CT was done in relation to gestational age (n = 2) or these were performed at a later gestational age (n = 1). APL was treated in 5 and 1 patients according to the AIDA protocol and the 7+3 plus ATRA one, respectively. RESULTS: All the patients with APL achieved remission after the first cycle of induction CT; 5 of the 6 patients did at the moment of delivery; one patient underwent emergency delivery during cytopenia after the cycle. The gestational age at delivery after CT was 34 (34-40) weeks. Spontaneous term labor occurred in 2 patients at an obstetric hospital. Cesarean section was made in 4 of the 6 patients. All babies were born alive, healthy, and without developmental abnormalities. Their age at the time of analyzing the results was 2.5 months to 15 years. Four of the 9 patients are presently alive. Late recurrences occurred in 3 (33%) patients. The median overall survival is 26 (0.25-128) months; the median relapse-free survival is 17.5 (0-127) months. CONCLUSION: APL treatment in pregnant women, which is aimed at saving two lives, is effective and reasonable.

[Cryptococcosis in hematology practice].

AIM: To study the clinical manifestations of cryptococcosis, its diagnostic features, and treatment results in patients with hemoblastoses. SUBJECTS AND METHODS: The study included adult patients with cryptococcosis treated at the Hematology Research Center (HRC) in 2005 to 2011. The diagnosis of cryptococcosis was established on the basis of isolation of Cryptococcus neoformans from a blood culture or determination of positive cryptococcal antigen in the cerebrospinal fluid (CSF) of patients with infection symptoms. RESULTS: During 7 years, 19 patients aged 19 to 68 years (median 47 years) were diagnosed as having cryptococcosis. In the pattern of cryptococcosis, there was a preponderance of patients with lymphoma (31%) and those with acute lymphoblastic leukemia (26%) at the stages of hemoblastosis remission induction (32%) and consolidation (26%). The diagnosis was made in 9 (47%) patients at the Intensive Care Department, HRC. The major risk factors of cryptococcosis were previous cytostatic drug exposure (68%), use of immunosuppressive and glucocorticoid drugs (63%), and granulocytopenia (42%). Seventeen (78%) patients were diagnosed with cryptococcal meningitis or meningoencephalitis; 1 patient had cryptococcal sepsis and 1 patient had possible cryptococcal pneumonia. All the patients were given antifungal agents. Amphotericin B, fluconazole, and a combination of antimycotics were used as first-line drugs in 16 (84%), 1 (5.5%), and 2 (10.5%), respectively. When their health became better, the patients were treated with voriconazole or fluconazole. Within 30 days after the diagnosis of cryptococcosis, 5 (26%) patients died; of them 2 had tumor progression concurrent with infection. CONCLUSION: In cryptococcosis, the central nervous system is predominantly involved in the infectious process. The determination of cryptococcal antigen in CSF is a necessary diagnostic component in meningitis and meningoencephalitis in patients with blood system tumors, lymphatic ones in particular. When cryptococcosis is timely diagnosed and treated, its mortality, when the tumor is controlled, is lower than that in other invasive mycoses.

[Results of treatment for candidemia in patients with blood system tumors].

AIM: To study the etiology, clinical manifestations, risk factors, and results of treatment for candidemia (CE) in patients with blood system tumors. SUBJECTS AND METHODS: The investigation included the patients with CE and hemoblastoses treated at the Hematology Research Center, Ministry of Health of the Russian Federation, in 2006 to 2012. The diagnosis of CE was established according to the single isolation of Candida spp. from blood cultures and the presence of infection symptoms. RESULTS: Over 7 years, CE was diagnosed in 57 patients aged 17 to 77 years (median age 48 years). Among the patients with CE, there was a preponderance of those with lymphomas (54%) and acute leukemias (30%). The pathogens of CE were C. albicans (33%), C. guilliermondii (26%), C. parapsilosis (12%), C. krusei (8%), C. lusitaniae (5%), C. famata (4%), C. tropicalis (4%), C. glabrata (4%), and C. pelliculosa (4%). The major risk factors were polychemotherapy (85%), granulocytopenia (63%), mucosal Candida spp. colonization (82%), the presence of central venous catheter (CVC) (97%), antibiotics (100%), and glucocorticosteroids (70%). The infection occurred with the intake of an antifungal agent in 33% of the patients; 60% had concomitant infections of other etiology. Antifungal agents were given to 52 (91%) patients. Within 30 days after CE diagnosis, 20 (35%) patients died; of them 12 (60%) patients showed tumor progression concurrent with the infection. The cure rate for CE was significantly higher in the use of echinocandin as a first-line drug (92%), in complete or partial remission in hemoblastosis (90%), CVC removal (76%) and in the administration of an antifungal drug on day 1 of detection of positive blood cultures (75%). The cure rate was significantly lower when septic shock developed and a patient was transferred to an intensive care unit (15%), when amphotericin B was used as a first-line drug (45%), when granulocytopenia occurred (53%), or glucocorticoids were given (55%). CONCLUSION: Candida non-albicans constitute a high proportion among the pathogens of CE. A number of risk factors influencing survival rates in CE have been identified. It is crucial to use echinocandin as a first-line agent as soon as possible after isolation of Candida spp. from blood cultures.

[A case of spontaneous chylothorax complicating pregnancy].

The paper gives a clinical case of left-sided chylothorax developing in a young woman in the second half of pregnancy due to thrombosis of the left internal jugular vein, left subclavian vein, and brachiocephalic trunk. Cesarean section was made. Medical treatment thereafter proved to be effective. The possible mechanisms for spontaneous venous thrombosis and chylothorax during pregnancy and the methods of their diagnosis and treatment are discussed.

[Fibrinolysis system in patients with sepsis in state of myelotoxic agranulocytosis].

PURPOSE: Hemostasis disorders are the part of multiple organ failure (mOF) in sepsis. This work objective is to evaluate the system parameters in septic patients. PATIENTS AND METHODS: 55 oncohaematological patients were included in study: 45 with sepsis and 10 patients in control group (no signs of infection). Septic patients were subdivided into septic patients without multiple organ failure, patient with multiple organ failure and patients with septic shock. The C-reactive protein (CRP), procalcitonine (pCT), interleukine-6 (IL-6) serum concentration and fibrinolysis parameters were measured Patients were examined daily during first 5 days, later once a week during 28 days, control group was examined one time. RESULTS: Levels of CRP IL-6 and PCT were raised since 1st day. PCT and IL-6 concentrations were higher in sepsis and MOF group and septic shock group, than in sepsis without MOF group. CRP was raised in all patients. PCT went to normal at 7th day, CRP and IL-6 have started to decrease after 7th day, but both were higher than in control group. T-PA and plasmin inhibitors were comparable to control group and haven't changed significantly. Septic shock patients and patients with MOF have shown a decrease of plasminogen activity. Patients without MOF have shown an initially decreased plasminogen activity, but after 2 days it was similar to control group. PAI-I activity was increased only in septic shock and MOF groups in first days, and was similar to control group in cases of no MOF. Exended XIIa-dependent fibrinolysis time in average was present in all septic patients since 1st day, and extended twice in MOF and septic shock groups. Clot lysis time tended to decrease starting from 8th day, but it was longer than in control group till 28th day. A raised D-dimer concentration compared to control group was present in 75% of patients, but no difference was found among subgroups. A raised D-dimer serum concentration was relevant for prognosis. CONCLUSION: The most sensitive diagnostic test in sepsis is XIIa-dependent fibrinolysis. Plasminogen and PAI-I activity changes are mostly present inpatient with MOF and septic shock. The 28-day survival rate was 60% in MOF and septic shock groups and 95% in no MOF groups. A raised D-dimer concentration was found in 75% of septic patients.

[Nine-year experience in the treatment of patients with diffuse large B-cell lymphosarcoma].

AIM: To ascertain indications to standard (CHOP-21/R-CHOP-21) and intensive (mNHL-BFM-90) treatment in patients with diffuse large B-cell lymphosarcoma (DLBCL) with involvement of lymphoid organs. MATERIAL AND METHODS: The trial, performed from January 2002 to December 2010, enrolled 139 DLBCL patients with affected lymph nodes (LN), tonsils, spleen, bone marrow (BM). The diagnosis was made according to WHO criteria. The patients were examined according to the protocol of lymphoproliferative diseases. Biopsy material from all 139 patients was studied immunohistochemically on paraffin blocks (LN, tonsils, spleen, BM) using a wide panel of antibodies. The same examinations of BM were made in all 18 cases of BM involvement. Cytogenetic examination was performed in 106 patients: 48 standard cytogenetic tests, 139 - FISH for t (14;18) as well as rearrangement of locus 3q27. Patients with a poor prognosis (n = 86, 61.8%) received intensive therapy according to mNHL-BFM-90 program. The signs of a poor prognosis were the following: massive tumor (tumor size more than 7.5 cm), invasion into the adjacent organs or tissues, stage III-IV disease by Enn-Erbor, high concentration of LDG. Patients without a poor prognosis (n = 53, 38.2%) received standard treatment CHOP-21 (n = 28) or R-CHOP-21 (n = 25). RESULTS: A complete remission without recurrences was achieved in all 53 patients without signs of unfavourable prognosis (100%). Overall 5-year survival was 96%, 2 patients died in remission of other causes. Of 86 patients with a poor prognosis a complete remission was achieved in 64 (74.4%) patients. Overall and recurrence-free 5-year survival was 65 and 86%, respectively. CONCLUSION: Standard treatment provided long-term complete remission in all the patients without poor prognosis. Intensive (mNHL-BFM-90) treatment produced the best results in generalized lesion without BM involvement. Overall 5-year survival was 84% in these patients and 12% in patients with BM involvement.

[A case of legionellesis pneumonia verified by isolation of Legionella pneumophila serogroup 1 from bronchoalveolar lavage fluid treated with levofloxacine and tigecycline].

A male patient received non-chemotherapeutic drugs which induced deep neutropenia complicated with sepsis, bilateral pneumonia, acute respiratory insufficiency. Artificial pulmonary ventilation was applied. The examination of bronchoalveolar lavage showed the presence of the culture L. pneumophila (serogroup 1) in a concentration 2 x 10(3) CFU/ml. Antibacterial therapy with levofloxacin in a dose 1000 mg/day was conducted. In a week not only L.pneumophila but also Acinetobacter baumanii was isolated from bronchoalveolar lavage. Tigecyclin was added to levofloxacin treatment. Two air cavities were found in the left lung. The treatment reduced the size of these cavities, infiltrative changes in the lungs and respiratory insufficiency regressed. The patient was discharged from hospital This case is the first case in Russia of L.pneumophila isolation from bronchoalveolar lavage. The case is also characterized by use of tigecycline for treatment of combined legionella and akinetobacterial infection and cavities in the lungs in legionella pneumonia.

[Assessment of cardiac output and intrathoracic blood volume by means of transpulmonary thermodilution and ultrasound dilution: similarities and differences].

UNLABELLED: The aim of the study is to compare results of the assessment of cardiac output and intrathoracic blood volume by two methods--transpulmonary (TTD) and ultrasound (UTD) thermodilution. MATERIALS AND METHODS: The prospective study included 58 patients (sepsis, septic shock, acute respiratory distress syndrome, intracranial haemorrhages), which underwent femoral artery catheterization with "Pulsiocath" 5Fr catheter (PICCO technology). For the means of ultrasound the catheter was connected to the central venous catheter by an arteriovenous loop. Sensors on arterial and venous ends of the loop registered the time and the volume of the indicator, blood properties and the ultrasound curve. Cooled (0 to 8 C) 5% glucose solution was used as an indicator for TTD, while heated (up to 37C) 0.9% NaCl solution was used as an indicator for the ultrasound. The cardiac output (CO) was measured by TTD and UTD, the global end diastolic volume (GEDV) by TTD, its analogue total end diastolic volume (TEDV) by UTD, intrathoracic blood volume (ITBV) by TTD and central blood volume (CBV) by UTD. 218 pairs of measurements were conducted. Oscillations of CO (TTD) were 2.76-16.3 l/min (8.6 +/- 2.48 l/min) and of CO (UTD)--2.92-18.1 l/min (8.72 +/- 2.65 l/min). There was a strong correlation between CO (TTD) and CO (UTD). The systematic mistake was 0.12 l/min, percentage based mistake--20.9%. ITBV correlated with CBV. There was a big systematic mistake found, which measured as much as 323 ml, the percentage based mistake was 36.5%. The correlation between GEDV and TEDV was (r = 0.70, p < 0.01). The TTD ejection fraction (23.2 +/- 5.6%) was lower (p < 0.01), than by UTD (57.8 +/- 15.2%). RESULTS: Both methods demonstrate close values of CO. GEDV was higher than TEDV and physiological heart volume. The absolute values of GEDV and ITBV measured by TTD are higher than the actual ones, although they reflect the changes of blood volume and can be used as dynamic preload parameters.

[Toxicity of different treatment protocols for acute myeloid leukemias in adults: the results of four Russian multicenter studies].

AIM: To comparatively analyze the toxicity of 4 treatment protocols in patients with acute myeloid leukemia (AML), which were used in the Russian multicenter center in 1992 to 2009. MATERIALS AND METHODS: The information obtained in 4 Russian multicenter studies conducted in 33 hematology departments of 26 cities and towns of the Russian Federation in 1992 to 2009 was analyzed. Randomization was made in 243 patients with AML (median age 38 years) in 1992-1995, 396 patients (median age 39 years) in 1995-1999, 392 patients (median age 39 years) in 2001-2006, and 137 patients (median age 40 years) in 2006-2009. The analysis excluded patients with acute promyelocytic leukemias who were recruited in the AML-92 and AML-95 studies. These patients' statutory forms adequately filled in were 60-70% therefore toxicity was analyzed on the basis of the data of 631 patients. RESULTS: The baseline clinical and laboratory parameters in the patients enrolled in the studies in different years slightly differ in the count of leukocytes at the onset of the disease and in the level of lactate dehydrogenase (LDH): the recent studies revealed a larger number of high-risk group patients (leukocytes more than 30 10(9)(/l; LDH more than 500 units) possibly due to the later diagnosis of AML. During the studies, the number of complete remissions remained as before (55%) after the first course and increased from 65 to 78% after the second course using cytosine arabinoside in high doses. Despite treatment intensification, mortality in the induction period remained as before (19-21%). Remission mortality decreased from 18 to 10-13%. The long-term results of using the aggressive therapy did not differ from those obtained during the standard treatment protocols. The duration of leucopenia after standard induction courses during the all studies remained equal (17-19 days); the exclusion was a HAM course as the second induction course after which the duration of neutropenia was much more than that of the standard course (17 and 10 days, respectively). During the study years, there was an increase in platelet transfusion volumes (from 20 to 53 doses during the first course and from 7 to 28 doses during the second course) and a reduction in the percentage of severe hemorrhagic complications. The incidence of pneumonias remained at the same level (40-50%) during the induction courses and that of septic complications and necrotic enteropathy considerably decreased from 40-46 to 17-19%. The incidence of invasive aspergillosis during the current programs from AML treatment was 10% (two induction courses), that of invasive candidiasis was 4.7% (two induction courses). CONCLUSION; The long-term results of treatment for AML were virtually unchanged regardless significant therapy intensification. Mortality remained high during induction treatment and in the postremission period. Its cause is severe infectious complications developing during myelotoxic agranulocytosis. The results of the analysis provide the basis for developing a new AML treatment protocol that should take into account all the merits and demerits of the previous protocols and provide a toxicity-treatment efficiency balance.

[Approbation of a new test system determining the activity of a plasmin inhibitor in patients with sepsis].

Plasmin inhibitor (PI) determination is an essential diagnostic method. The purpose of the study was to develop an amidolytic assay for estimating PI activity, by applying the test system made by RENAM (Moscow). The new system is based on purified plasmin (human plasma) with the activity attested by the international standards. The developed method shows precision and accuracy with low and normal PI activity. The pilot clinical trial in patients with sepsis had demonstrated that the PI activity determined by this method is associated with some hemostatic parameters (prothrombin index, thrombin generation) and a patient's status (septic shock, hepatic dysfunction).