[Use of streptase in acute thromboses of the major veins].
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Biomedical subjects
Publications and source records attributed to S V Rodionov.
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The main principle of the antithrombotic therapy in acute thrombosis of major veins is to eliminate the thrombotic state of the homeostasis system by means of a simultaneous correction of pathological changes in all the three main links of this system. The authors believe the joint application of anticoagulants, antiaggregants and fibrinolysis activators to be necessary for the elimination of the state mentioned. The doses should be chosen in order to normalize the parameters of hemocoagulation, fibrinolysis and aggregation of thrombocytes.
Eight-year experience in conducting antithrombotic prophylaxis, by methods elaborated by the authors, in 93 patients operated on for acute thrombosis in the system of venae cavae superior and inferior is generalized. On the basis of the results, the authors advanced the main principle of antithrombotic prophylaxis, the necessity for simultaneous correction of disorders of blood coagulation, fibrinolysis, and aggregation of formed elements of the blood. They showed that the efficacy of postoperative antithrombotic prophylaxis depends on the presence and character of hemodynamic disorders in the involved extremity. It is established that general fractional heparinization is not suitable for antithrombotic prophylaxis due to low efficacy and high rate of hemorrhagic complications. Continuous regional infusion of rheopolyglucin-heparin mixture with nicotinic acid and Trental ensures in most cases correction of the thrombotic condition of hemostasis and effective prevention of rethrombosis of the major veins with minimum hazard of hemorrhagic complications.
Prior to the treatment 39 patients with osteogenic sarcoma were examined for some cell immunity indices by the skin-allergic reaction of delayed hypersensitivity (RDH) and the reaction of suppression of leucocytes migration (RSLM). As an antigen a polysaccharide fraction of osteogenic sarcoma was employed, for the control--normal bone polysaccharide fraction. In 25 patients the course of the disease was followed up for 8--14 months after the primary examination. Both RDH and RSLM were found to show no essential difference in the reactions for polysaccharide antigens isolated from osteogenic sarcoma and normal bone. In patients with a rapid growth of the primary tumor negative RSLM was noted, while RDH indices failed to show such differences. In patients without any signs of the progressing disease during 8--14 months since the moment of the examination, as a rule, positive RSLM and RDH are noted. In patients with a precipitous course of the disease 1--8 months prior to the treatment negative RSLM and RDH are more frequently observed.
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The paper provides the results of multimodality conservative therapy in 527 patients with chronic obliterating diseases of extremity arteries, which was performed in the outpatient setting. Factors influencing its efficiency were analyzed. The paper emphasizes the value of this direction of treatment whose underestimation sharply aggravates the prognosis of these diseases, including the results of their surgical management. Having obtained positive results in 84.5% of patients, the authors note the efficiency of treatment to be decreased with severe arterial insufficiency of lower extremities (5% of negative results in Stage IIa, 23% in Stage IIb, and 40% in Stage III), in patients with prior surgical interventions, and in elderly patients with atherosclerosis obliterans and younger patients with non-specific aortoarteritis.
Fibrinolytic therapy with streptokinase preparations was administered to 79 patients. Hemorrhagic, embolic, thrombotic, and allergic complications were observed over the course of therapy. Massive bleedings occurred in 3 (4%) patients, two of them died. Negligible hematomas at the site of vessel puncture were seen in 11 (14.4%) cases. Distal arteries embolization developed in 6 (7.6%) patients. Nine patients (11.4%) developed early re-thromboses soon after therapy was over. Allergic reactions presenting as hyperthermia and short-term chill were observed in one third of the patients. Measures to prevent possible complications of fibrinolytic therapy are strict adherence to thrombolysis methods and a dynamic laboratory monitoring over the course of therapy.