PREDICTION OF VARIOUS FORMS OF POSTOPERATIVE ACUTE LIVER FAILURE.

165 patients over 18 years in the period from January 2014 to March 2015 were studied. The aim was to investigate the prognostic significance of known scale assessment of organ dysfunction in respect ofpostoperative hepatic failure. The development of acute liver failure was assessed on the basis of clinical and laboratory data, severity of the condition by scales MELD, Child-Turcotte-Pugh, Maddrey, Schindl, BILE score, SOFA. The paper identified the incidence offorms of acute liver failure (hepatic encephalopathy, hepatic coagulopathy, hepatorenal syndrome, systemic hemodynamic disorder mixed form) in patients after surgery on hepatobiliary system, and the dependence of the probability of their occurrence on the severity of the condition, calculated using a scales in the preoperative period. Calculated sensitivity and specificity in predicting scales investigatedforms of acute liver failure based on ROC-analysis. It was shown that the specialized rating scales have good predictive accuracy in respect of certain forms of hepatic insufficiency (Child-Tur-cotte-Pugh -for hemodynamic options and hepatic coagulopathy, MELD and SOFA scales -for hepatic encephalopathy SCHINDL -for hepatorenal syndrome and mixed forms of hepatic failure). None of the analyzed scales do not possess predictive value with respect to all forms of hepatic failure.

[Specification of the development risk of thromboembolic complications in abdominal surgery].

The retrospective research included 1983 patients with different abdominal surgical pathology. Parameters of homeostasis were estimated in preoperative period and early postoperative period. Frequency of occurrence and relevance of different clinical risk factors of thrombosis were analyzed. The rate of development of thromboembolic complications was investigated in studied subgroup of patients. It was revealed, that high risk groups of thrombosis progress were the patients with malignant disease of the pancreas, the esophagus, the large and straight intestine as well as obstructive jaundice of malignant genesis. The most significant clinical factors were the presence of malignant process, accompanied by cardiac pathology, dehydration and high number (3 and more) on ASA scale.

[Diagnostics and correction of coagulopathy in pregnant women and puerperas with gestosis].

INTRODUCTION. Gestosis is a complication of normal pregnancy which for long years takes the 2-3rd place in maternal and perinatal mortality and women morbidity structure. 396 patients with moderate and heavy gestosis from 2007 to 2011 were studied. In 53 women (13.4%) it was accompanied by complex haemostasis disturbances and part of women had sepsis. Therefore the retrospective differential analysis of haemostasis disturbances with algorithm presented in this article was carried out. Haemostasis status, complete blood count, biochemical blood analysis data were analyzed. Correction of haemostasis disturbances in the postnatal period was performed according to legacy recommendations. As a result of retrospective differential diagnostics of haemostasis disturbances, the chronic disseminate intravascular clotting (DIC) syndrome, a HELLP-syndrome, thrombotic thrombocytopenic purpura (TTP) and a haemolytic uremic syndrome (HUS) were revealed. The received results indicate that in obstetrics there are essential difficulties with coagulopathy timely diagnostics, especially, TTP and HUS. The most difficult problem is differential diagnostics between a HELLP-syndrome, TTP and HUS. Clear algorithm of differential diagnostics appeared only in 2010. We analyzed all coagulopathy cases since 2007. TTP and HUS were diagnosed by 3rd days of the postnatal period, also specific therapy of these syndromes was late that was reflected in ICU length-of-stay, frequency of sepsis and need of uterectomy respectively.

[Thrombophilia and principle of thrombosis prevention in obstetrics].

One of the major causes of maternity death are complications of venous thromboembolism (VT). Risk of their occurrence during pregnancy is 5 to 10 times higher comparing to non-pregnant women. Hereditary trombophilia and antiphospholipid syndrome increase the risk of complications of venous thromboembolism significantly. In addition to VT, trombophilia is associated with miscarriage, placental abruption and severe preeclampsia. The aggravating factor is the presence of certain limitations in administration of some medications for thrombosis prophylaxis during pregnancy. Issues of medical care in pregnant patients with thrombophilia, artificial heart valves or acute VT complications are highlighted in the article, as well as principles of thrombosis prophylaxis during cesarean section or in women with VT in anamnesis. Evidence based recommendations of the recent American College of Chest Physicians consensus conference are presented for each issue.

[Comparative evaluation of enoxaparin and non-fractionated heparin in patients with pancreonecrosis]. / Sravnitel'naia otsenka énoksaparina i nefraktsionirovannogo geparina u bol'nykh pankreonekrozom.

Hemostasis dysfunction plays an important role in the pathogenesis of pancreonecrosis. Platelet and clotting factor activation in the presence of hyperfibrinogenemia and suppressed fibrinolysis develop during the stage of pyonecrotic complications, which provokes microcirculatory disorders, the main cause of pancreonecrosis progress. Treatment with nonfractionated heparin (NFH) for prevention of blood clotting does not prevent the development of the DIC syndrome, as, despite its anticoagulation activity, the drug possesses proaggregation effects and is devoid of the profibrinolytic effect. Laboratory signs of the DIC syndrome were detected in the majority of patients treated with NFH (decreased level of antithrombin III, prothrombin index, and fibrinolysis suppression). Blood clotting prevention with clexane (enoxaparin) was effective, as this drug did not stimulate platelet aggregation and promoted the maximum realization of fibrinolysis, the defense function of the hemostasis system. The absence of microclots in capillaries of patients treated with clexane manifested by intensification of tissue perfusion and hence, more effective draining of destruction zone. Increase of tissue perfusion outside the destruction zone prevented the dissemination of necrosis and disease progress, i.e. promoted the elimination of one of the most important mechanisms of pancreonecrosis pathogenesis.