К 120-ЛЕТИЮ СО ДНЯ РОЖДЕНИЯ АКАДЕМИКА АКАДЕМИИ МЕДИЦИНСКИХ НАУК, ГЕРОЯ СОЦИАЛИСТИЧЕСКОГО ТРУДА Ф.Г. КРОТКОВА

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ВЛИЯНИЕ ПРОДЛЕННОЙ ТЕРАПИИ ЭНОКСАПАРИНОМ НА РИСК РЕЦИДИВА ВЕНОЗНЫХ ТРОМБОЭМБОЛИЧЕСКИХ ОСЛОЖНЕНИЙ И РЕКАНАЛИЗАЦИЮ ТРОМБИРОВАННЫХ ВЕН

The article presents the results of its own study of the effect of long-term (not less than 30 days) enoxa-parin therapy (1 mg/kg administered subcutaneously every 12h) on the risk of recurrent venous thromboembolic complications (VTC) and recanalization of thrombosed deep veins. The enoxaparin therapy was compared with a standard approach to treatment (unfractionated heparin for not less than 5 days followed by the administration of warfarin). The extended enoxaparin therapy was significantly more effective than standard treatment due to its impact on the risk of recurrent deep vein thrombosis (DVT) and recanalization of thrombosed deep veins. On top of that, the effect of enoxaparin in the first month of treatment of VTC episodes last for the next 11 months. As a result, the extension of enoxaparin therapy was associated with an 88% reduction in the risk of DVT recurrence during 12 months of anticoagulant therapy and a 2.5-fold increase in the probability of recanalization of venous occlusions by the end of the first year of treatment compared with the standard therapy with unfractionated heparin and warfarin.В статье представлены результаты собственного исследования, посвященного изучению влияния продленной (не менее 30 дней) терапии эноксапарином (1 мг/кг подкожно каждые 12 часов) на риск рецидива венозных тромбоэмбо-лических осложнений (ВТЭО) и реканализацию тромбированных глубоких вен. Для этого терапию эноксапарином сравнили со стандартным подходом к лечению (нефракционированный гепарин не менее 5 дней с переходом на прием варфарина). Продленная терапия эноксапарином оказалась значительно эффективнее стандартного лечения по влиянию на риск рецидива тромбоза глубоких вен (ТГВ) и реканализацию тромбированных глубоких вен. При этом эффект от применения эноксапарина в первый месяц лечения эпизода ВТЭО сохранялся на протяжении последующих 11 месяцев. Так, продление терапии эноксапарином ассоциировалось со снижением риска рецидива ТГВ в течение 12 месяцев анти-коагулянтной терапии на 88% и с увеличением вероятности реканализации венозных окклюзий к концу первого года лечения в 2,5 раза по сравнению со стандартной терапией нефракционированным гепарином и варфарином

Современные подходы к обеспечению качества диагностики в компьютерной томографии

To ensure the quality assurance of CT-examinations, it is necessary to obtain the high-quality diagnostic information and maintain the optimal exposure levels of patients and medical staff. This paper is focused on the requirements and main aspects of quality assurance of CT-examinations, which include quality control of the equipment, methods of CT-image quality control, optimization of radiation protection, as well as management of the unintended and accidental medical exposure. The paper contains recommendations on quality control of diagnostic equipment, methods for monitoring the quality control of CT-images, values of diagnostic reference levels for the detection of abnormally high patient doses and optimization of the radiation protection of patients, as well as the recommendations for management of radiation and non-radiation accidents. All main sections of the paper represent an unified quality assurance system in computed tomography.Обеспечение качества проведения компьютерно-томографических исследований способствует как получению необходимой диагностической информации, так и поддержанию оптимальных уровней облучения пациентов и персонала в этой области лучевой диагностики. В статье рассмотрены требования и основные аспекты обеспечения качества при проведении КТ-исследований, которые включают контроль качества оборудования, методики контроля качества КТ-изображения, методики проведения исследований, вопросы оптимизации радиационной защиты, а также предотвращения и расследования радиационных аварий. Все основные разделы статьи представляют из себя рекомендации по применению единой системы обеспечения качества проведения КТ-исследований

RADIATION HYGIENE: INTERACTION OF SCIENCE AND PRACTICE

A short sketch of history of radiation hygiene formation as a scientific discipline is presented, its conventional directions are outlined, and the perspectives of development are pointed out. Examples of co-operation of scientists and specialists in health protection practice in the field of radiation hygiene are presented

РАДИАЦИОННАЯ ГИГИЕНА: СВЯЗЬ НАУКИ И ПРАКТИКИ

A short sketch of history of radiation hygiene formation as a scientific discipline is presented, its conventional directions are outlined, and the perspectives of development are pointed out. Examples of co-operation of scientists and specialists in health protection practice in the field of radiation hygiene are presented.Представлен краткий экскурс в  историю становления радиационной гигиены как научной дисциплины, выделены ее традиционные направления, намечены перспективы развития. Приведены примеры сотрудничества ученых и специалистов практического здравоохранения по радиационной гигиене

FACTORS ASSOCIATED WITH D-DIMER ELEVATION IN PATIENTS WITH VENOUS THROMBOEMBOLIC EVENTS

Aim. To study the factors associated with elevated D-dimer levels in patients with acute venous thromboembolic events (VTEE). material and methods. The study included 111 patients (76 men and 35 women aged 18–76 years) with a first or repeat episode of deep vein thrombosis (DVT) and/or pulmonary embolism (PE) in the last 2 months. The majority of the patients (n=80) received unfractionated heparin (UFH) for at least 5 days, followed by warfarin (international normalized ratio (INR) control at least once a month; target INR 2,0–3,0). Some patients (n=31) received therapeutic doses of enoxaparin (1 mg/kg subcutaneously, every 12 hours) for at least 30 days, followed by warfarin treatment. D-dimer levels (norm <0,5 mkg/ml) were measured by the latex agglutination method, with the use of “STA LIATEST >® D-DI” reagents (Diagnostica Stago). Results. D-dimer levels varied from 0,02 to 9,96 mkg/ml (median 1,05 mkg/ml, interquartile range 0,49–1,99 mkg/ml) and exceeded the upper norm limit in 74% of the patients. There was a positive association between D-dimer levels and thrombus “size” (r=0,304; p<0,001), and a negative association between D-dimer levels and >< 0,001), and a negative association between D-dimer levels and thrombus “age” (r=-0,418; p<0,001). Predictors of D-dimer elevation were identified among 150 demographic, anthropometric, anamnestic, clinical, laboratory, genetic, or ultrasound parameters and VTEE risk factors. The results of the multivariate stepwise regression analysis demonstrated that female gender, chronic heart failure (CHF), VTEE symptom duration ><28 days, and thrombus “size” >< 0,001). Predictors of D-dimer elevation were identified among 150 demographic, anthropometric, anamnestic, clinical, laboratory, genetic, or ultrasound parameters and VTEE risk factors. The results of the multivariate stepwise regression analysis demonstrated that female gender, chronic heart failure (CHF), VTEE symptom duration <28 days, and thrombus “size” >< 28 days, and thrombus “size” < 6 points were independent predictors of D-dimer elevation in the acute period of DVT/PE. Conclusion. D-dimer levels, measured 32 (23–44) days after the development of DVT/PE symptoms, were elevated in 74% of the patients. D-dimer elevation in the acute period of VTEE was associated with female gender, CHF, “age” and “size” of the thrombus