[Imbalance in the proteinase-inhibitor system in obstetric sepsis and septic shock]. / Disbalans protinazno-ingibitornoi sistemy pri akusherskom sepsise i septicheskom shoke.

The condition of proteinase-inhibitor balance was studied in blood plasma of patients with obstetric sepsis. Hypoproteinemia (due to a massive blood loss and toxic effect) was shown to result in a 2-5-fold decrease of the activity of endogenous proteinases in blood plasma versus the control group. The activity of alpha-macroglobulins was also by 2 times lower versus the controls, while the activity of alpha 1-antichymotrypsin and of an acid-stable inhibitor of trypsin was found to be higher by 20-30%. A degree of imbalance of proteinase/inhibitor depends on a disease severity.

[The role of biologically active substances in the pathogenesis of dysfunctional uterine hemorrhage in the climacteric period]. / Znachenie biologicheski aktivnykh veshchestv v patogeneze disfunktsional'nykh matochnykh krovotechenii klimaktericheskogo perioda.

The activities of the blood kallikrein-kinin system components (plasma kallikrein, alpha 1-antitrypsin, alpha 2-macroglobulin), and gonadotropin levels in various phases of the menstrual cycle were measured in 35 women ob various age groups. The same parameters were investigated in 28 women with dysfunctional uterine bleedings of the climacteric period. Phasic changes in the blood kallikrein-kinin system components, closely related to the hormonal status, were revealed over the course of the onto-genesis. Climacteric dysfunctional uterine bleedings were found associated with an elevated activity of the plasma kallikrein, parallelled by a relative insufficiency of the blood plasma inhibitor potential. A relationship between the activities of the blood kallikrein-kinin system components and endometrial function has been revealed. These findings necessitate search for approaches to pharmacologic regulation of the blood kallikrein-kinin system activity and to pathogenetic therapy of the climacteric dysfunctional uterine bleedings.

[The therapeutic characteristics of massive blood loss in puerperae with gestosis]. / Osobennosti terapii massivnoi krovopoteri u rodil'nits s gestozom.

A regimen of fluid and transfusion therapy has been developed on the basis of clinical and laboratory evaluation of postresuscitation course and outcomes of parturients with massive blood loss and a history of gestosis. An early introduction and systematic use of proteolytic inhibitors were beneficial. Surgical hemostasis warrants a radical approach and requires ligation of internal abdominal arteries and uterus extirpation.

[Various indicators of the kallikrein-kinin system of the blood in patients of reproductive age with dysfunctional uterine hemorrhage]. / Sostoianie nekotorykh pokazatelei kallikrein-kininovoi sistemy krovi u bo'lnykh s disfunktsiona'lnymi matochnymi krovotecheniiami reproduktivnogo perioda.

Fifteen women with dysfunctional uterine hemorrhages [DUH] of the reproductive period and ten women aged 20 to 30 with normal two-phase menstrual cycle were examined. Measurements of the blood plasma kallikrein and prekallikrein activities in normal females have revealed a direct correlation between kallikrein level and colpocytologic data and an inverse correlation between prekallikrein level and these data. An incessant growth of kallikrein content was detected in DUH patients, whereas their prekallikrein levels were much lower than in the controls. A manifest activation of the kallikrein-kinin system was detected in the patients with DUH of the reproductive period, augmenting with the development of the proliferative processes in the endometrium.

[Differential approach to cesarean section in current obstetrics]. / Differentsirovannyi podkhod k kesarevu secheniiu v sovremennom akusherstve.

A survey of cesarean sections performed between 1984 and 1987 has demonstrated a changing pattern of indications for abdominal delivery. An expanded range of indications for cesarean section in cases of breech presentation and maternal gestosis has been shown to reduce significantly perinatal losses. It is demonstrated that indications for vaginal delivery in patients with a uterine scar should be expanded through further search for new methods for the assessment of the scar as well as the improvement of the available ones. Intraoperative administration of antibiotics is a method of choice in preventive antibiotic treatment.

[Enzyme-inhibitory imbalance in suppurative-infective diseases in puerperants]. / Narusheniia fermentno-ingibitornogo balansa pri gnoino-septicheskikh zabolevaniiakh u rodil'nits.

The blood plasma granulocyte elastase activity and the urine acid-fast inhibitor level have been measured in 23 healthy puerperae and in 65 puerperae with various pyo-septic complications in the postpartum period. These parameters have been found stable in healthy puerperae and shifted in those with pyo-septic complications: elastase activity increased parallel with the reduction of the acid-fast inhibitor level. The most manifest shifts in the enzymatic inhibitor balance have been observed in the puerperae with peritonitis. These data indicate the pathogenetic role of the enzymatic inhibitor imbalance in the development of pyo-septic complications postpartum.