[Disorders of the hemostasis system in patients with mitral valve prolapse]

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).

[The ability of low-molecular heparin (Fraxiparin) to overcome the action of exogenous coagulases--a fundamental difference from nonfractionated heparin]

A new previously unknown activity of the low molecular-weight heparin Fraxiparin (Sanofi) has been discovered. This is its ability to reduce the plasma clotting action of snake venom coagulases at final concentration of more than 12.5 anti-Xa U/ml, while the unfractionated heparin does not possess this property. The experiments demonstrated that Fraxiparin the action of Echis carinatus prothrombin-activating venom to a greater degree and Agkistrodon halys halys thrombin-like coagulase to a lesser degree. Unlike the unfractionated heparin, Fraxiparan also prevents the death of white rats from acute toxic hemocoagulant shock caused by the intravenous injection of DL100 Echis carinatus venom.

[Antiphospholipid syndrome and resistance to replacement therapy in hemophilia]

The paper described the appearance of lipoid anticoagulant (LA) in the presence of hepatitis B virus in the blood of hemophilia A patient. Profuse and long-term bleeding after the extraction of the tooth that failed to be treated with big doses of cryoprecipitation was noted. Intense replacement therapy resulted in the appearance of factor VIII inhibitor in a titre of 4.5 units per ml in the patient's blood. Big-dose prednisolone therapy helped an immediate arrest of the bleeding and a rapid decrease in LA titration. The levels of factor VIII inhibitor preserved in the same values. The study exhibited the ability of LA to impede the arrest of the bleeding and the response to the replacement treatment in hemophilic patients.

[Effect of heparin on erythrocyte damage in various toxicogenic DIC syndromes]

In experiments in vitro it has been established that heparin does not have a direct hemolyzing action, but it significantly reduces red blood cell resistance to acid. In experiments in vivo heparin significantly intensifies red blood cell resistance to the action of acid hemolytics. Hemolysis during intoxication with the toxins studied is, to a greater extent, secondary in relation to the intravascular blood coagulation.

[Substantiation, tactics and effectiveness of frozen plasma-enzyme inhibitor therapy in septicemia and infectious-destructive processes]

Nonvalidated transfusions of fresh frozen plasma (with the aim of blood loss substitution, for parenteral feeding, etc.) are widely used in the current clinical practice. In disseminated intravascular coagulation syndrome (DICS) its use is undoubtedly indicated, but only by jet-injection, combined with low doses of heparin, and simultaneous administration of high doses of protease inhibitors (kontrikal, etc.); such treatment should be conducted at the early stages of the process, and not in the period of complete noncoagulation and profuse hemorrhage. The treatment was applied to 194 patients with sepsis and 147 patients with acute infectious-destructive diseases of the lungs; in 12 patients plasmapheresis was used simultaneously. More rapid, than in the compared group, arrest of fever and decrease of intoxication, recovery of microcirculation in the organs, increased accessibility of the infection foci for antibiotics, more than twofold reduction of lethality were recorded during this treatment. The data obtained have evidenced that infectious-septic DICS is an indication for cryoplasma-antienzyme therapy. Expenditure of fresh frozen plasma for many other purposes could be significantly diminished.

[Plasmapheresis in combined treatment of severe forms of abscesses and gangrene of the lungs]

With an adjuvant course of plasmapheresis, a combined treatment of severe acute abscesses and gangrene of the lungs brought about a marked short-term clinical response in 48 out of 50 treated patients. The responders had their temperature returned to normal, amount of sputum significantly reduced. They recovered good appetite and gained weight. There was also attenuation of DIC syndrome and endotheliosis, improvement of cellular and humoral immunity. Upon the discharge 35 patients had complete or partial response, 10 patients developed a chronic process. Lethal outcomes reached 10%.

[Use of equipment for external fixation and rehabilitation of patients with hemophilia]

External fixation apparatus (EFA), hing-distraction and compression-distraction, were used in 30 hemophiliacs for the treatment of hemophilic arthrosis, intra-articular and extra-articular fractures, contractures, dislocations, as well as after synovectomy. The treatment was conducted under cryoprecipitate protection, the dose of which was significantly decreased after granulation around the pins was completed. Immediate and late results of the treatment showed its higher effectiveness as compared to other correction methods (gypsum etc). After correction with EFA repeated hemorrhage and trauma were less frequent, and mean annual cryoprecipitate expense decreased five-fold. No severe complications were recorded. EFA enable successful treatment of such diseases of the locomotor system that are unaffected by other therapeutic measures.

[Effect of heparin on fibrinogen formation during experimental toxic syndrome of disseminated intravascular coagulation]

The formation of circulation components of fibrinogen pool in toxigenic syndrome of disseminated intravascular blood coagulation (DBC-syndrome) caused by the Vipera lebetina turanica venom has been examined by the gel-filtration method. Simultaneously it has been studied what components of fibrinogen pool are removed in paracoagulation tests and with addition of the coagulating enzymes (thrombin, reptilase and the Echis multisguamatus venom) to the plasma. The preliminary heparinization of animals poisoned by Vipera lebetina turanica venom was found to prevent the fibrinogen formation mainly at the fibrin-monomer formation stage. Besides, the effect of polymerization inhibition was revealed in the plasma of such animals.