Vol 31, No 6 (2014)

Articles
SURGICAL TECHNIQUE FOR TRANSVENTRICULAR SEGMENTAL SUTURAL MITRAL VALVE ANNULOPLASTY IN ISCHEMIC INSUFFICIENCY
Sukhanov M.S.
Abstract
Aim. To describe the technique for transventricular segmental sutural annuloplasty of mitral valve. Materials and methods. Predictors for mitral valve annuloplasty performed through the left ventricular access in chronic aneurism of the left ventricle associated with ischemic mitral insufficiency were determined. The method was compared with ring mitral annuloplasty of the mitral valve. Results. The technique for transventricular mitral valve annuloplasty is comparable with the ring mitral annuloplasty. Conclusions. In practice, this technique showed sufficient efficiency and simplicity; it is less traumatic. During the study, relative indications and contraindications for application of this technique were determined.
Perm Medical Journal. 2014;31(6):6-11
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MODERN APPROACHES TO DIAGNOSIS AND TREATMENT OF MEDIASTINUM NEOPLASMS IN CHILDREN
Rudakova E.A., Valiulov I.M., Openysheva A.V., Kulinich R.A., Kovaleva O.A., Startsev D.A.
Abstract
Aim. To assess modern possibilities for diagnosis and treatment of mediastinum neoplasms in children. Materials and methods. During the period of 1998-2013, seventy children with volume mediastinum neoplasms underwent treatment at the clinic of children’s surgery. Two groups of patients were formed depending on the technique of operative intervention: 39 patients were operated with thoracoscopy (main group); 31 patients underwent an open surgery (control group). Children’s age was from some months to 14 years. Diagnostic techniques included: ultrasound (US), multiple view roentgenological investigation, computer tomography (CT), magnetic-resonance tomography (MRT), laboratory tests. When conducting comparative assessment of surgical techniques, the following parameters were taken into consideration: operation duration, hemorrhage, terms of artificial pulmonary ventilation, need and duration of staying at resuscitation unit, character and duration of postoperative anesthesia, complications. Results. In the structure of children’s mediastinum neoplasms, there prevail neurogenic tumors (40 %) and archenteron tumors (24,3 %). Use of US, CT, MRT significantly widens the notion of topography of volume processes in the mediastinum, the correlation between the neoplasm and the surrounding organs and tissues. Comparative analysis of the results of treatment of children operated with open and endosurgical techniques showed the advantage of thoracoscopy. Conclusions. It is necessary to use differentiated approach to treatment of children with mediastinum tumors taking into account the age, sizes and character of neoplasms.
Perm Medical Journal. 2014;31(6):12-19
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SURGICAL TACTICS IN ULCEROUS GASTROINTESTINAL HEMORRHAGES
Petrov Y.V., Fedorov S.V., Khunafin S.N., Vlasov A.F.
Abstract
Aim. To analyze the results of surgical treatment of gastrointestinal hemorrhages. Materials and methods. The results of treatment of 464 patients with hemorrhages from chronic gastric and duodenal ulcers were analyzed by us. Patients were divides into two groups depending on treatment. In group 1 (control, n =111), treatment of ulcerous hemorrhages was performed with traditional techniques, in group 2 (main, n =353) - morphological and histological status of vessels and architectonics in the zone of ulcer was studied. The type of hemorrhage (arterial or venous) can be used as a criterion for determination of surgical tactics in ulcerous gastroduodenal hemorrhages. Results. According to the type of hemorrhage, patients were distributed in the following way: 58 (16,4 %) had arterial hemorrhage, but 295 (83,6 %) - venous. Differential diagnosis was carried out by clinical, endoscopic and laboratory data. For the first time, the method for assessment of significance of using the type of hemorrhage for determination of surgical tactics in ulcerous gastroduodenal hemorrhages was developed (RF Patent Invention №2407445; 27.10.2010). Conclusions. Efficiency of conservative therapy was on average 80%: venous hemorrhage - 78,2%, arterial - 1,8%. So, it needs to use an active surgical tactics for patients with arterial type of hemorrhage and active-differential one - for those with venous type of hemorrhage.
Perm Medical Journal. 2014;31(6):20-24
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UTILIZATION OF DAMAGED SEGMENTS IN RESTORATION OF INJURED HAND FUNCTION
Kozyukov V.G., Tokarev A.E., Nenakhova Y.V.
Abstract
Aim. To improve functional abilities of the posttraumatic hand stump after reconstructive surgeries using the damaged tissue segments. Materials and methods. Experience of treatment of 58 patients with different posttraumatic hand stumps was summarized. To restore grasp function, the damaged tissue resources of the injured hand were used; new techniques for surgical treatment based on the principles of performing local-plastic surgeries were offered. The character of reconstruction corresponded to the form of the posttraumatic defect of the hand and included transplantation or displacement of finger fragments and metacarpal bones as well as their distraction lengthening. In addition to clinical, there were applied radial, biomechanical, electrophysiological and statistical methods of investigation. Results. In all cases, reconstructive operations using the preserved and damaged tissues resulted in improvement of functional abilities of hand stumps. In most observations (80 %), bilateral grasp of injured hand was restored, in the rest patients - flat and hamate grasps. Conclusions. Damaged tissues and segments of the injured hand used in local-plastic surgeries permit to significantly improve its functional abilities and to restore important types of grasps.
Perm Medical Journal. 2014;31(6):25-30
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CLINICOELECTRONEUROMYOGRAPHIC PECULIARITIES OF PERIPHERAL DISTAL POLYNEUROPATHY IN PATIENTS WITH METABOLIC SYNDROME AND HYPOTHYROIDISM
Erasheva M.V., Chernyshova T.E., Styazhkina S.N., Ledneva A.V., Poryvaeva E.L., Mikhailov A.Y.
Abstract
Prevalence of metabolic syndrome in the total population is 14-24%, metabolic syndrome associated with hypothyroidism occurs in 5-10 % of cases. Aim. To study the polyneural disorders in patients with metabolic syndrome using clinicoelectroneuromyographic characteristics. Materials and methods. Clinical and electroneuromyographic examination of patients with metabolic syndrome and hypothyroidism was carried out; peculiarities of the course of peripheral polyneuropathy in this group of patients were singled out. To clarify electroneuromyographic characteristics, stimulation technique for fibular, tibial, sural nerves was used; “F-wave” index was analyzed. Results. According to cumulative clinical and electroneuromyographic data, sensor polyneuropathy was diagnosed in 22 (55 %) patients with metabolic syndrome and sensomotor polyneuropathy - in 16 (40 %), normal parameters - in 2 (5 %) patients. Conclusions. The obtained data have broadened our knowledge on complications of metabolic syndrome and on inclusion of peripheral distal polyneuropathy with metabolic syndrome into the group of dismetabolic polyneuropathies.
Perm Medical Journal. 2014;31(6):31-38
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RISK FACTORS FOR DEVELOPMENT OF UNFAVORABLE PERINATAL OUTCOMES AND EFFECT OF DRUGS ADMINISTERED TO PREGNANT WOMEN
Skryabina V.V.
Abstract
Aim. To reveal the most significant factors influencing development of unfavorable perinatal outcomes and to assess the efficiency of drugs administered to pregnant women for their prevention. Materials and methods. On the basis of retrospective analysis of medical documents belonging to 34 women with physiological and 255 patients with complicated course of gestation, risk factors for development of unfavorable fetal and newborn outcomes (perinatal mortality, congenital malformation and hypoxia at birth) and effect of drugs administered to pregnant women were analyzed. Results. Among the factors increasing the risk for development of unfavorable fetal and newborn gestation outcomes, the most significant and early detected ones were chronic somatic, gynecological as well infectious and inflammatory diseases revealed during pregnancy. Out of traditionally administered to pregnant women drugs, the most evident positive effect on perinatal outcomes was connected with use of drugs for vaginal sanation, immunomodulators, disaggregants and actovegin (pyracetam). Early administration of any drugs permitted in pregnancy notably decreased the risk for newborn perinatal mortality and hypoxia. Conclusions. Among the examined patients, the most significant and early detected risk factors for development of unfavorable fetal and newborn outcomes are chronic infectious-inflammatory diseases diagnosed before and during pregnancy. Decrease in risk for unfavorable perinatal outcomes is connected with administration of drugs for vaginal sanation, immunomodulators, disaggregants and activegin (pyracetam) as well as early onset of therapeutic and preventive measures.
Perm Medical Journal. 2014;31(6):39-47
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RESULTS OF LYMPHOTROPIC REGIONAL RETINALAMINE THERAPY IN COMPLEX NEUROPROTECTOR TREATMENT OF PATIENTS WITH COMPENSATED PRIMARY OPEN-ANGLE GLAUCOMA
Drugov A.V., Subbotina I.N., Gavrilova T.V.
Abstract
Aim. To study the long-term results of neuroprotector retinalamine therapy in patients with open-angle glaucoma. Materials and methods. 48 patients (77 eyes) including 20 men and 28 women with compensated primary open-angle glaucoma (POAG) of initial (I) and developed (II) stages were examined. Group I (main) involved 27 patients, 40 eyes (mean age 63,28±8,86 years): stage I glaucoma was detected on 24 % of eyes, stage II - on 76%; against the background of traditional complex neuroprotector therapy retinalamine was administered lymphotropically on the side of the damaged eye. Group 2 (control) included 21 patients, 37 eyes (mean age 64,65±7,92 years); traditional neuroprotector therapy was performed. Results. After the course of treatment, visual function improved in both groups, however, in the main group - 0,1 increase in visual acuity was observed in 50% of cases, but in the control - only in 29,8%. The number of scotomas in the standard points decreased in the main group by 3 times, in the control - by 1,5times. Three months later, these functions remained previous in both groups. Six months late, both groups indicated fall in the visual acuity and rise in the number of scotomas, but in the main group vision fall was registered in 10 % of cases, and in the control - in 32,4 % of cases. Positive dynamics was fixed in the main group during the period up to 24 months in 24 patients on 37 eyes (93,5 %). In the control group, stabilization of visual functions during the same period was reached in 59,2 %. Conclusions. Dedystrophic therapy courses combined with lymphotropic introduction of retinalamine increase the efficiency of treatment and contribute to long preservation of visual functions in patients with primary open-angle glaucoma at the initial and developed stages.
Perm Medical Journal. 2014;31(6):48-51
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IMMUNITY STATUS IN PATIENTS WITH BASAL CELL SKIN CARCINOMA
Maslyakov V.V., Dralina O.I., Fedotova E.V., Zakharov G.V.
Abstract
Aim. To study the immune status in patients with basal cell skin carcinoma in the postoperative period. Materials and methods. The immune status changes were performed in 39 patients with basal cell skin carcinoma (BCSC). Patients’ age was 65±3 years. To asses the immune status, content of different lymphocyte subpopulations in blood, immune humoral component indices, cytokine content, phagocytosis parameters were determined. Results. Patients with basal cell carcinoma were established to have in cell component of the immune system decreased percent and absolute number of lymphocytes carrying CD16+, CD3+, CD4+ and CD8+ mediators and lowered CD4+/CD8+ ratio index. At the same time, increase in lymphocytes carrying CD20+ receptors was registered. After surgical treatment, restoration of lymphocytes carrying CD20+ receptors alone was noted; the rest indices were not changed and remained decreased. Before surgical treatment, in the humoral component of the immune system, there was registered a decrease in IgG number, as well as reduction in the total number of compliment, its C3-and C4-fractions, TNF-α, IL1-b, IL-6, IF-γ, phagocytic index, phagocytic number, BT-sp., BT-st., with rise in CIC. On the postoperative day 7, a partial restoration of the humoral component indices of the immune status system was detected: CIC and NBT-sp. which became to correspond to the data of the comparison group consisting of relatively healthy persons were also restored. On the postoperative day 10, NBT-st. index was restored, besides, there was a partial restoration of such index as IgG. However, this index remained decreased compared to the data of the comparison group consisting of relatively healthy persons.
Perm Medical Journal. 2014;31(6):52-58
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SURGICAL TREATMENT OF DEFORMING FIRST METATARSOPHALANGEAL FOOT ARTICULATION OSTEOARTHROSIS
Tokarev A.E., Kozyukov V.G., Nenakhova Y.V.
Abstract
Aim. To optimize the surgical tactics for treatment of patients with deforming osteoarthrosis of the first metatarsophalangeal articulation of the foot depending on the stage of disease. Materials and methods. Long-term results of treatment of the first metatarsophalangeal articulation osteoarthrosis were analyzed in 50 patients depending on the character of pathology and stage of disease. Clinical and roengenological study, biomechanical and statistical methods were used in diagnosis and management. Differentiated surgical tactics for treatment was developed, a new technical solution was offered. Outcomes of surgical treatment were followed up in 36 (72,2 %) patients. Good results were reached in 31 (86,1 %) patients, satisfactory - in 5 (13,9%) patients. Conclusions. Differentiated approach to treatment of osteoarthrosis of the first metatarsophalangeal articulation of the foot in most cases gives positive results and depends on choice of optimal method in each concrete case taking into account the degree and severity of deformation.
Perm Medical Journal. 2014;31(6):59-62
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IMPACT OF UREAPLASMIC INFECTION ON GESTATION COURSE
Melnikova T.A.
Abstract
Aim. To study the impact of Ur. urealyticum on the course of pregnancy and labour depending on the degree of infection. Materials and methods. Complex laboratory examination of pregnant women was performed to reveal significance of ureaplasmic infection. Ureaplasmosis was diagnosed using indirect methods of diagnosis - polymerase chain reaction, quantitative bacteriological analysis. Results. As a result of analyzing the course of gestation period, it was detected that women with ureaplasmosis more often had complicated pregnancy and threat of abortion at all terms of gestation. Fetoplacental insufficiency was more often observed in women infected with Ur. urealyticum in the concentration of ³104 KOE/ml. Miscarriage occurred more often in case of infection with Ureaplasma urelyticum . Conclusions. The course of gestation in women with ureaplasmic infection is characterized by greater occurrence rate of complications.
Perm Medical Journal. 2014;31(6):63-68
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CLINICOLABORATORY PARALLELS BETWEEN SPECIES COMPOSITION OF ORAL MICROBIOTA AND GENERAL SOMATIC PATHOLOGY IN PATIENTS WITH PERIODONTITIS
Tamarova R.R., Mavzyutov A.R.
Abstract
Aim. To establish the presence and character of relationship between species composition of microorganisms associated with periodontitis and concomitant somatic pathology. Materials and methods. 106 patients with periodontitis (observation group) and 66 patients without parodentium pathology were examined after oral cavity sanation (comparison group). Test-systems developed by us were used to study with PCR method the occurrence rate of P. gingivalis, T. denticola, S.oralis, S. sanguis, S. mutans, S. salivarius, S. sobrinus, S. macacae in the dental parodontal pocket and saliva content . Results. General somatic pathology among periodontitis patients was registered more often (by 33,2 %) than in comparison group ( p =0,0001). At the same time, in the group of observation, patients with periodentitis and general somatic pathology had parodontal pocket S. mutans, S. oralis, S. sobrinusus reliably more often (by 45 %, 43,2 % and 33,8 %, respectively, p <0,01) than patients of the same group without concomitant somatic pathology. Conclusions. Among patients with chronic periodontitis, qualitative changes in oral microbiocenosis are associated with functional status of different organs and systems of macroorganism.
Perm Medical Journal. 2014;31(6):68-73
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NEW OPPORTUNITIES FOR USING FIBRINOLYTICS AND CORTICOSTEROIDS IN TREATMENT OF POSTOPERATIVE INFLAMMATORY COMPLICATIONS IN CATARACT SURGERY
Subbotina I.N., Devyatkova A.S., Gavrilova T.V., Drugov A.V.
Abstract
Aim. To analyze the efficiency of new methods for administration of fibrinolytics and corticosteroids in treatment of postoperative inflammatory complications in cataract surgery. Materials and methods. During ten months of 2014, sixteen patients with the postoperative inflammation after cataract extraction were followed up. Results. In the early postoperative period after extraction of cataract, there occurred complications of inflammatory type on 16 eyes: on 10 eyes (0,78 %) - after 1275 ultrasonic cataract phacoemulsifications and on 6 eyes (2,62 %) - after 229 extra-and intracapsular cataract extractions. Complex of traditional antibacterial and anti-inflammatory therapy included fibrinolytic gemaze into the front camera and glucocorticosteroid diprospan into the subtenon space of the eye. Full arrest of inflammatory symptoms occurred on the day 2-3 after introduction of these drugs. Conclusions. Single administration of fibrinolytic into the front camera and corticosteroid into the subtenon space contributed to faster arrest of inflammatory process and prevention of endophthalmitis.
Perm Medical Journal. 2014;31(6):74-77
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TO THE PROBLEM OF NEW BIOPATHOGEN TYPES
Konovalov P.P., Arsentiev O.V., Buyanov A.L., Denisov N.L.
Abstract
Perspective directions of work on development of new types of biopathogens are presented in the paper. Convention on prohibition of biological weapon does not prevent development of new biopathogens. Success in gene engineering and molecular biology opens huge opportunities for receiving new biological agents and modification of the known ones. The basic directions in development of new types of biopathogens are the following: modification of especially dangerous infectious agents; modification of slow infectious agents; modification of uncontrolled infectious agents; synthesis of regulatory genes on the basis of viral vectors; modification of latent viruses; modification of oncogenes and oncogenic viruses; development of movable genetic elements based on phages, plasmids et c; synthesis of genes coding immunoprivileged organ and tissue proteins; modification of animal and plant toxins with elevated resistance to environmental factors; synthesis of genes coding formation of chemical and low concentration biological compounds with toxic or other regulatory effect. Development of new biopathogens will be accompanied by working out new methods for delivering such agents to the target. It is possible to develop a weapon possessing a high degree of selectivity and damaging genome of organism-target of a certain race, ethnos, nation.
Perm Medical Journal. 2014;31(6):78-81
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MORPHOMETRCIC CHARACTERISTICS OF RENAL VENOUS VESSELS IN MATURE, ELDERLY AND OLD MEN AND WOMEN BY ROENTGENOANGIOGRAPHY DATA
Kafarov E.S., Fedorov S.V., Buluev A.B., Elzhurkaeva L.R., Vagabov I.U.
Abstract
Aim. To determine the morphometric characteristics of venous vessels of the right and left kidneys in men and women of mature, elderly and old periods of ontogenesis by roentgenoangiography data. Materials and methods. 200 human kidneys received from the corpses of persons of both sexes who had died at the age of 22 to 90 years from diseases not connected with renal pathology (Astrakhan forensic medical examination bureau) served as a material for the study. Kidneys were withdrawn with vascular complex. Red lead injected into the renal venous canal was followed by Zolotukhin-Prives roentgenography; 200 roentgenoangiograms were used to perform morphometry of human renal venous vessels. Results. Morphometric indices of renal venous vessels were growing in the first and second periods of mature age ( p ≤0,05), however, in the elderly and old periods no statistically significant changes were observed. Conclusions. Sex differences between morphometric parameters of renal veins and venous vessels forming them consist in insignificant prevalence of these parameters among men.
Perm Medical Journal. 2014;31(6):82-86
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HYGIENIC STATUS DYNAMICS AT AMBULATORY SURGICAL INTERVENTIONS STAGES
Leonova L.E., Sutorikhina A.S., Pavlova G.A., Popov A.V.
Abstract
Aim. To determine the dynamics of patients’ oral hygiene level at the stages of ambulatory surgical interventions. Materials and methods. 65 patients aged 18-45 who addressed for rendering ambulatory surgical aid experienced complex dental examination. Dental caries prevalence and intensity indices, oral hygiene and parodentium tissues status were studied; a survey with a developed questionnaire was carried out to examine 65 patients for the purpose of determining the level of hygienic knowledge and habits. Results. The performed studies revealed a high prevalence and intensity level of the main dental diseases among patients who addressed for rendering ambulatory surgical aid. Rare visits to dentists, unbalanced nutrition and unsatisfactory habits of individual hygiene were noted. Conclusions. Introduction of complex preventive program results in positive dynamics of dental status indices that subsequently leads to decrease in general morbidity of patients.
Perm Medical Journal. 2014;31(6):87-90
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APPROACHES TO DIAGNOSIS OF PATHOLOGICAL HEART TRANSFORMATION IN QUALIFIED SPORTSMEN
Kallaur E.G., Marinich V.V., Shantarovich V.V.
Abstract
Aim. To develop the methods of modern diagnosis of pathological transformation of the heart in sportsmen going in for cyclic kinds of sport. Materials and methods. At the example of baidarka and canoe pullers, the results of the study aimed at investigating the changes in standard ECG, echocardiography, biochemical marker of myocardium lesion in sportsmen with stress cardiomyopathy signs are presented. Results. Vegetative and metabolic disorders in sportsmen (baidarka and canoe pullers) with the signs of stress cardiomyopathy are accompanied by reduction in ability to work. Conclusions. The obtained data permit to broaden the spectrum of studies used in sport cardiology.
Perm Medical Journal. 2014;31(6):91-104
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HYGIENIC GROUNDING FOR PREVENTIVE SANITARY-TECHNICAL MEASURES WITH SYLVINITE UNITS EXPLOITATION
Kirichenko L.V., Barannikov V.G., Varankina S.A., Khokhryakova V.P., Maslov Y.N., Dementiev S.V.
Abstract
Aim. To carry out hygienic estimation of dynamics of the basic medical factors of saline units (SU) while their exploitation for the purpose of grounding preventive sanitary-technical works. Materials and methods. Saline microclimatic wards “C” (SMW “C”) of different exploitation periods (to 1 month, from 1 to 2 years, and more than 2 years) were studied. By means of hygienic methods, the main medical factors including saline aerosol concentration, radiation background, aeroionization were determined. Microbial landscape of the air by the total microbial number, presence of mycelia and yeast fungi as well as golden staphylococcus with inoculation of the corresponding media was estimated. Results. Dependence of physical factors of internal environment on operation life of sylvinite units was found. Increase in the period of saline units’ exploitation caused decline in air aeroionization. In a year after SMW exploitation, mycelia and yeast fungi having a marked allergenic effect on patient’s organism were detected. Conclusions. To correct the main therapeutic factors, additional air preparation and mechanical treatment of reaction surface of the mineral is to be carried out in 1 year after SU exploitation.
Perm Medical Journal. 2014;31(6):105-109
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THROMBOCYTOPENIA SYNDROME IN A CHILD WITH TYPE II MUCOPOLYSACHARIDOSIS
Averianova N.I., Rudavina T.I., Domnina N.A.
Abstract
A case of thrombocytopenia syndrome in a child with type II mucopolysacharidosis (Hunter’s syndrome) is presented in the paper. From the age of 3, thrombocytopenia was observed in child’s blood analyses. At the age of 8, against the background of hemorrhagic syndrome critical decrease in platelet level was revealed. Differential diagnosis with immune thrombocytopenic purpura was performed.
Perm Medical Journal. 2014;31(6):110-114
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A CASE OF HEREDITARY THROMBOPHILIA AND WARFARIN SKIN NECROSIS
Borodina E.N., Bachurina M.A.
Abstract
A clinical case of hereditary thrombophilia caused by mutation of blood coagulation factor V (Leidan mutation) is presented in the paper. The peculiar features of this case are: first - heterozygote mutation manifested at the age of 30, second - development of a rare side effect of indirect oral anticoagulant - warfarin - skin necrosis. Warfarin necroses occur in deficiency of C and S proteins. Combination of genetic defects in the system of hemostasis and pathology of gastrointestinal tract originated from patient’s childhood led to essential changes in pharmacodynamics and pharmacokinetics of indirect anticoagulant. This clinical example demonstrates need in introduction of moleculogenetic testing into clinical practice not only for diagnosis, but for choosing drugs, as well. Pharmacogenetic approach can be one of the keys to individualization of drug therapy.
Perm Medical Journal. 2014;31(6):115-121
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