Effects of artificial tears on ocular surface in glaucomatous patients with long-term instillation of preserved antiglaucoma eye drops
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01.01.2018 |
Makashova N.
Vasilieva A.
Kolosova O.
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Vestnik Oftalmologii |
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0 |
Ссылка
© 2018 Media Sfera. All rights reserved. Purpose. To study the effects of long-term instillation of 0.18% sodium hyaluronate artificial tears VISMED multi on ocular surface in glaucomatous patients with long-term instillation of preserved anti-glaucoma drops. Material and methods. The study included 79 patients (40 female and 39 male; 79 eyes in total) with primary open-angle glaucoma (POAG) divided into 3 groups according to disease stage: mild or early (stage I) glaucoma - 15 patients (15 eyes), moderate (stage II) glaucoma - 30 patients (30 eyes), advanced or severe (stage III) glaucoma - 34 patients (34 eyes). Conjunctival and corneal changes were assessed with Norn's test, Schirmer I test and corneal fluorescein staining test. All patients completed Ocular Surface Disease Index (OSDI) questionnaire. Corneal compensated intraocular pressure (IOPcc) was measured using Ocular Response Analyzer (ORA) (Reichert Optics Inc., USA). In addition to hypotensive therapy, all patients received instillations of 0.18% sodium hyaluronate (VISMED multi) three times every day. After 14 days, all examinations were repeated. Results. The condition of eye surface in patients with moderate and advanced (stage II and III) glaucoma depends on the degree of IOPcc compensation. As glaucoma increases in severity, the pathological changes in the ocular surface progress. Instillations of 0.18% sodium hyaluronate solution lead to significant improvement of the test results in all groups, and in early glaucoma patients it restores all objective indicators to normal values. Conclusion. Treatment with 0.18% sodium hyaluronate solution (VISMED multi) leads to statistically significant (p<0.05) improvement of ocular surface condition in glaucoma patients with long-term instillation of preserved antiglaucoma eye drops.
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What are the opportunities of prasugrel in the treatment of patients with acute coronary syndrome?
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01.01.2018 |
Gilyarov M.
Konstantinova E.
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Rational Pharmacotherapy in Cardiology |
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© 2018, Stolichnaya Izdatelskaya Kompaniya. The aim of the review is presenting the possibilities and perspectives of the third generation of thienopyridine P2Y12 receptor inhibitor prasugrel in the treatment of patients with acute coronary syndrome (ACS). The main pathogenetic stage of ACS is intracoronary thrombosis, which develops on the surface of a damaged atherosclerotic plaque. The use of acetylsalicylic acid with addition of the second antiplatelet agent, so-called dual antiplatelet therapy, is a standard component in the treatment of any type of ACS, regardless of reperfusion and the selected treatment strategy. Due to some limitations in the use of clopidogrel as the second component of dual antiplatelet therapy, the possibility of prasugrel or ticagrelor usage should be considered in patients with ACS with percutaneous coronary intervention (PCI). Prasugrel therapy is associated with better clinical outcomes as compared with clopidogrel therapy in moderate or high-risk patients who undergo PCI. Because of higher bleeding risk and the lack of clinical benefits in special subgroups of patients, prasugrel must not be used in patients with a stroke or transient ischemic attack in the past. If, after a thorough individual benefit-risk assessment a decision is in favor of prescribing prasugrel to the patient older than 75 years or with a small body weight the maintenance dose of prasugrel is to be reduced by half. Real clinical practice data has shown that with following these recommendations prasugrel demonstrates optimal efficacy, safety, and even more significant impact on the prognosis than this in clinical trials. Prasugrel is able to reduce significantly the incidence of cardiovascular events such as cardiovascular death, myocardial infarction and stroke in patients with ACS who undergo PCI.
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Vestibular vertigo treatment in a polymorbid patient
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01.01.2018 |
Kosivtsova O.
Yavorskaya S.
Fateeva T.
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Nevrologiya, Neiropsikhiatriya, Psikhosomatika |
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© 2018 Ima-Press Publishing House. All rights reserved. Many physicians have difficulty managing patients with vertigo. Incorrect routine diagnoses are frequently made in patients with peripheral vestibulopathy, which makes therapy fail. Most cases of vestibular vertigo are caused by peripheral vestibular disorders (otolithiasis, hydrops, neuronitis). Rehabilitation maneuvers are effective in the treatment of benign paroxysmal positional dizziness; salt-free diet, diuretics, and betahistine dihydrochloride are for Mnire's disease (syndrome); vestibular rehabilitation is for vestibular neuronitis. Betahistine dihydrochloride is most effective among all the medicines used in different causes of vestibular vertigo, including that of unclear origin. The paper gives the positive experience with betahistine made in Russia for vestibular vertigo.
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Cranial dystonia
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01.01.2018 |
Tolmacheva V.
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Nevrologiya, Neiropsikhiatriya, Psikhosomatika |
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© 2018 Ima-Press Publishing House. All rights reserved. Cranial dystonia is a common disease of the extrapyramidal nervous system. The clinical manifestations of dystonia are extremely variable; many of its forms are often undiagnosed. Dystonia is a sensorimotor disorder of the nervous system. Damage affects not only one structure, but also a network of the nodes interacting with each other in the somatosensory cortex and associative sensory and motor fields, which play a role in the integration of various sensory modalities coming from both outside the body and from the receptors within it. Botulinum toxin preparations show the highest efficacy in treating cranial dystonia. If their administration cannot achieve a positive result, oral drugs and surgical treatments should be used.
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On dissociative amnesia
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01.01.2018 |
Maksimova T.
Prokhorova S.
Demidova V.
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Nevrologiya, Neiropsikhiatriya, Psikhosomatika |
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© 2018 Ima-Press Publishing House. All rights reserved. The paper describes a clinical case of dissociative amnesia in a 22-year-old patient. A marked hysterical radical was observed in premorbid. As a result of the psychotraumatic situation, the patient twice lost memories of the events of his life, could not remember his name, place of residence. At the same time, his ability to memorize new information, training knowledge, and some dance skills were preserved. Instrumental examinations detected no organic pathology. Memory in both cases was fully restored within a few months. Patients with similar symptoms were increasingly encountered in psychiatric practice. At the same time, there are different viewpoints on the occurrence of such symptoms. It is obvious that the problem of dissociative amnesia is relevant and requires further investigation.
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Post-stroke cognitive impairment (results of a 5-year follow-up)
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01.01.2018 |
Verbitskaya S.
Parfenov V.
Reshetnikov V.
Kozlov V.
Kabaeva A.
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Nevrologiya, Neiropsikhiatriya, Psikhosomatika |
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1 |
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© 2018 Ima-Press Publishing House. All rights reserved. Prior stroke plays an important role in the development of cognitive impairment (CI), the prevention of which requires detailed study. Patients and methods. A total of 350 patients (mean age, 65±17.7 years; 49% men) who had experienced a stroke with a small degree of neurological deficit were followed up. Cognitive functions were evaluated using the Mini-Mental State Examination (MMSE), Mattis dementia rating scale, the clock drawing test, the test on memorizing 12 words, and the Schulte table. During 5 years of follow-up, 61 (17.4%) patients died, including 45 (12.8%) from recurrent stroke; 89 recurrent strokes developed. Results. The first examination did not reveal CI in 59 (17%) patients; 73 (21%) were found to have marked CI (mild or moderate dementia). After 1, 3, and 5years of follow-up, the proportion of patients with marked CI increased up to 23.2, 29.5, and 34.5%, respectively. Within 5 years, there was an average decline of 2 MMSE scores. The maximum decrease in cognitive functions was seen in patients who had experienced a recurrent stroke, but this also occurred in the absence of a stroke. Cognitive functions were substantially better in a group of patients with blood pressure (BP) normalization. Conclusion. The 5-year follow-up has shown that post-stroke CI gradually progresses, which is associated with the progression of both vascular disease and a concomitant neurodegenerative process. BP normalization during antihypertensive therapy contributes to the prevention of progressive post-stroke CI.
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Use of probiotics during antimicrobial pharmacotherapy: Clinical and pharmacological aspects
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01.01.2018 |
Shih E.
Rebrova E.
Knyazeva S.
Ignatova L.
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Akusherstvo i Ginekologiya (Russian Federation) |
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0 |
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© 2018, Bionika Media Ltd. All rights reserved. Objective. To carry out a systematic analysis of the data available in the literature on rational therapy for vaginal microbiocenotic disorders during combined antibacterial therapy to optimize the use of probiotics. Material and methods. The review includes the data of foreign and Russian articles found in the international system Pubmed. Results. The polymicrobial etiology of the inflammatory process requires combined antibacterial therapy using 2–3 antibiotics, which predisposes to dysbiotic states and the growth of opportunistic pathogens, including Candida fungi. It is advisable to prophylactically take probiotics simultaneously with the initiation of antibiotic therapy, which is more effective than the use of probiotics immediately after completion of an antibiotic therapy cycle. The vagina can be colonized by probiotic bacteria following oral administration if acid-resistant strains of lactobacilli are used. Conclusion. It is expedient to simultaneously take acid-resistant probiotic strains per os during antibiotic therapy in order to restore a normal protective flora and to suppress the opportunistic intestinal microorganisms that are able to colonize the urogenital area.
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Comparison of the significance of the RENAL, PADUA, and C-index nephrometric scales for the prediction of the complexity of laparoscopic nephrectomy
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01.01.2018 |
Alyaev Y.
Sirota E.
Rapoport L.
Bezrukov E.
Sukhanov R.
Tsarichenko D.
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Onkourologiya |
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© 2018 ABC-press Publishing House. All rights reserved. Objective: to compare the predictive value of RENAL, PADUA, C-index nephrometry score systems according to projection of complexity of operative measure in terms of warm ischaemic time, extent of blood loss and rate of postoperative complications. Materials and methods. Information for the research was collected from 314 patients with localized kidney cancer, who had laparoscopic partial nephrectomy from January 2012 to May 2017. In 210 (66.8 %) cases, in addition to the routine examinations, 3D modelling and operative measure planning were carried out. The average tumor volume of the patients was equal to 62.5 ± 33.5 mm3. All patients before the operation were estimated the complexity of operative measure on the nephrometry score systems: PADUA, RENAL, C-index. The average sum of balls according to scale RENAL - 7.56 ± 1.12, on scale PADUA - 7.98 ± 1.55, on scale C-index - 2.76 ± 1.14. Then in retrospect by the method of logistic regression analysis was determined predictive value of RENAL, PADUA, C-index nephrometry score systems for prediction of warm ischaemic time, duration of operative measure, extent of intraoperative blood loss and possibility of rate of postoperative complications. Results. In 265 (84.4) cases transperitoneal approach was perfomed and in 49 (15.6 %) cases it was retroperitoneal approach. The average time of laparoscopic partial nephrectomy is 140.15 ± 55.8 min, the average time of ischaemic warm is 13.35 ± 7,65 min. The average extent of blood loss during the laparoscopic partial nephrectomy is 291.95 ± 196.5 ml. Intraoperative complications were found in 8 (2.54 %) cases. Postoperative complications were estimated according to the Clavien-Dindo classification of surgical complications and were found in 31 (9.9 %) cases, among them 12 (3.8 %) patients had surgical complications. The index of the RENAL nephrometry scoring system had the highest predictive value in the multivariant analysis for warm ischaemic time, extent of intraoperative blood loss and possibility of development after complications (p = 0.049; 0.028; 0.046). None of indices were significant for multivariant analysis of prognosis the duration of laparoscopic partial nephrectomy. The indices of the RENAL (p = 0.032) and C-index (p = 0.040) nephrometry score systems were significant for univariate analysis of prognosis the duration of the laparoscopic partial nephrectomy. Conclusion. The usage of RENAL, PADUA, C-index nephrometry score systems is useful for the prediction of warm ischaemic time, extent of blood loss, duration of operative measure and possibility of rate of postoperative complications at laparoscopic partial nephrectomy. According to our data the index of RENAL nephrometry scoring system has the highest predictive value. Applications of 3D modelling for counting nephrometry indices in preoperative period makes the process of counting balls easier on all three nephrometry score systems.
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On the occasion of his 180<sup>th</sup> birthday anniversary of ivan ivanovich neiding
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01.01.2018 |
Pigolkin Y.
Lomakin Y.
Khodulapov A.
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Sudebno-Meditsinskaya Ekspertiza |
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1 |
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© 2018 Media Sphera Publishing Group. All rights reserved. This article is devoted to the life and professional activities of the internationally renowned forensic doctor Ivan Ivanovich Neiding who became widely known in the early youth as the discoverer of the microscopic diagnostic features of the constriction marks formed in association with hanging and strangulation. During more than 22 years (from 1878 till 1900), I.I. Neiding acted as the head of the Department of Forensic medicine at the Moscow University where a large number of investigations on forensic medical ballistics, toxicology, obstetric and gynecological expertise were carried out under his supervision. At the time when I.I. Neiding headed the Department, the academic process was for the first time organized in the form of the specialized studies conducted by concrete specialists. Ivan Ivanovich Neiding himself was actively involved in the practical expert work and participated in the development of the procedural basis of the forensic medical expertise. In the hard times of political reaction, he managed to strengthen the role and position of the Department that was officially redesignated as the research institute.
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Trousseau’s syndrome: The forgotten past or actual present?
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01.01.2018 |
Vorobyev A.
Makatsaria A.
Brenner B.
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Akusherstvo i Ginekologiya (Russian Federation) |
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1 |
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© Bionika Media Ltd. Objective. To carry out a systematic analysis of the data available in the current literature on the modern view on Trousseau’s syndrome Material and methods. The review included the data of foreign and Russian articles published in the past 10 years and found in e-Library and PubMed on this topic. Results. This paper provides a pathogenetic explanation for the increased thrombotic potential in cancer patients, which underlies tumor growth and metastasis. In addition to direct thrombotic events, the paper also describes hemorrhagic complications resulting from systemic coagulopathy, including disseminated intravascular coagulation, hemolytic thrombotic microangiopathy, and excessive fibrinolysis. Conclusion. At present, any manifestation of thrombohemorrhagic complications in patients with malignant tumors can be classified as a paraneoplastic syndrome (Trousseau’s syndrome). In addition to Virchow’s classic triad, hyperproduction of tissue factor (TF), the main initiator of the extrinsic coagulation pathway, underlies the pathophysiology of Trousseau’s syndrome. At the same time, the substantial release of microparticles from TF-bearing tumor cells is critical not only for clot formation, but also for the progression of tumor growth.
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A study on the association of genes for pro-inflammatory cytokines and depression
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01.01.2018 |
Lezheiko T.
Andryushchenko A.
Korovaitseva G.
Kondratiev N.
Gabaeva M.
Krikova E.
Golimbet V.
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Zhurnal Nevrologii i Psihiatrii imeni S.S. Korsakova |
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© 2018, Media Sphera Publishing Group. All rights reserved. Objective. To study the association between proinflammatory cytokine genes and depression. Material and methods. IL-1B С-511T and TNF-a G-308A gene polymorphisms were studied in patients diagnosed with depression and age and sex-matched healthy controls. Results and conclusion. The IL-1B С-511T and TNF-a G-308A polymorphisms were associated with depression; CC genotype (р=0,001, OR=1.9 CI 1,3—2,7) and GG genotype (р=0,001, OR=3,0 CI 1,8—4,9) were the risk factors. The results suggest that immune factors may play a role in the development of depression. The authors highlight the role of clinical polymorphism of depression that makes it difficult to form homogenous groups of patients and to select phenotypes for biological studies.
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Safety and efficacy of thulium transurethral en block resection with fiber laser "Urlaz" for treatment of non-muscle-invasive bladder cancer
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01.01.2018 |
Sorokin N.
Enikeev D.
Dymov A.
Tsarichenko D.
Kislyakov D.
Gololobov G.
Severgina L.
Rapoport L.
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Onkourologiya |
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© 2018 ABC-press Publishing House. All rights reserved. Background. The high recurrence rate after conventional transurethral resection (cTUR) for bladder cancer (BC) requires search for more effective methods of surgical treatment. Objective: to evaluate the feasibility, safety, and efficacy of cTUR versus thulium laser en bloc resection of bladder tumors using new fiber laser "Urolaz". Materials and methods. 129 patients, who underwent surgical treatment for BC between 2015-2017 in urological department of I.M. Sechenov First Moscow State Medical University were included in the study. The cTUR were performed for 58 patients, 71 patients underwent thulium laser en bloc resection of bladder tumors. Results. The presence of detrusor muscle in specimen was 58.62 % in cTUR group and 91.55 % in thulium laser en bloc resection group respectively. Obturator nerve reflex, bladder perforation, and bleeding in thulium laser en bloc resection group were absent, therefore immediate instillation of chemotherapy was made in all these cases. Recurrence rate after 12 and 18 months after surgery in the group of en bloc resection was statistically lower compared to the cTUR group. Conclusion. The results, obtained in our study shows that thulium en bloc resection using thulium fiber laser "Urolaz" is feasible, effective and safe procedure for patients with BC. Thulium en bloc resection has a number of advantages over the cTUR: Absence of obturator nerve reflex, high quality of specimen for pathological examination (presence of detrusor muscle in specimen was 91.55 %) and low recurrence rate.
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Medical-biological aspects of recovery in professional and amateur sports
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01.01.2018 |
Achkasov E.
Mashkovskiy E.
Bezuglov E.
Predatko K.
Nikolaeva A.
Magomedova A.
Khomich R.
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Medical News of North Caucasus |
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© 2018 Stavropol State Medical University. All rights reserved. The review considers the basic principles of recovery after exercise in professional and amateur sports. Restoration of the body is the return of physical parameters to the initial values, increasing the adaptive capacity after performing physical work. Proper recovery after exercise helps avoid problems such as physical fatigue, lack of nutrient intake, injuries of various severity, dehydration, etc. A number of factors influence the human body during recovery: a balanced diet, adequate rest and sleep, psychological and emotional unloading, gymnastics, massage, contrast shower and others. Comprehensive rehabilitation programs in sports should include methods with proven effectiveness, take into account the individual characteristics of the athlete and the dominant form of physical activity, and consider the recovery period as an integral part of the entire training plan.
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Ethylmethylhydroxypyridine malate effect on hepar metabolic function in patients with different functional classes of chronic heart failure
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01.01.2018 |
Kukes V.
Shih E.
Zhestovskaia A.
Pavlova L.
Goroshko O.
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Medical News of North Caucasus |
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© 2018 Stavropol State Medical University. All rights reserved. Activity of CYP3A4 cytochrome P450 was examined in 90 patients with I-III functional classes of chronic heart failure (CHF) before and after the seven-day intravenous administration of Ethylmethylhydroxypyryridine malate (Ethoxidol) 100 mg/day. There was a statistically significant increase of CYP3A4 cytochrome P450 activity evaluated by urinary 6-β-hydroxycortisol/cortisol ratio in patients with I, II and III functional classes of CHF after seven day intravenous administration of 100 mg/day Ethylmethylhydroxypyryridine malate.
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Effect of the Content Complexity on Hesitations in Adolescents' Narratives
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01.01.2018 |
Ovchinnikova I.
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Psychology of Language and Communication |
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1 |
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© by Irina Ovchinnikova 2018. The paper presents analysis of the hesitations in adolescents' narratives. The speech disfluencies in the adolescents differ from those of the adults by frequency of self-corrections and pauses of hesitation. The adolescents rarely turn to repair their narratives but often interrupt the speech flow by pauses while telling a story stimulated by a wordless book. The lack of self-corrections reflects the specific problems with self-control and self-regulation due to immaturity of the executive function. Narrating about a complex multi-propositional event, the adolescents often experienced hesitation that provoked more self-repairs and hesitation pauses compared to the telling the story about a simple event. The description of the relatively simple content was more complicated syntactically than that of the multi-propositional event. Meanwhile, the content complexity significantly influences frequency of the silent hesitation pauses.
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Clinical masks of bone sarcomas in children: Six clinical cases
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01.01.2018 |
Rykov M.
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Voprosy Sovremennoi Pediatrii - Current Pediatrics |
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© 2018 Publishing House of the Union of Pediatricians. All rights reserved. Background. Solid tumors in children are one of the most common childhood malignancy, second only to hemoblastosis. Among solid tumours, about 5% are bone sarcomas: osteosarcoma (3%) and Ewing's sarcoma (2%). Atypicality of the these diseases course makes an early diagnosis a real challenge. Case Reports. The article presents six clinical observations of patients with bone sarcomas. We demonstrate the difficulties in diagnosing of this disease group which is associated with the absence of both specific symptoms and distinct clinical picture. Conclusion. Pediatricians and pediatric surgeons should take into account the possibility of atypical course of bone sarcomas in children. Low cancer alertness is the reason for a significant delay in establishing the correct diagnosis which contributes to the tumour process generalization and reduces the chances of achieving remission while increasing the cost of treating such patients.
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100th Anniversary of the Soviet maternal and child healthcare system: Successes, problems, and lessons
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01.01.2018 |
Baranov A.
Albitsky V.
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Voprosy Sovremennoi Pediatrii - Current Pediatrics |
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© 2018 Publishing House of the Union of Pediatricians. All rights reserved. The article presents the text of the authors' report at the plenary session of the XX Congress of Pediatricians of Russia (dated February 16, 2018) dedicated to the centenary of the Soviet state mother and child welfare system. The features of its formation and development were described. The most important achievements in the field of child health care were outlined. Attention is focused on the personalities of the first facilitators of pediatric healthcare in Soviet Russia. Authors summarise the findings resulting from the history of the Soviet pediatric service.
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The role of epidermal barrier impairments in atopic dermatitis: Modern concepts of disease pathogenesis
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01.01.2018 |
Murashkin N.
Ambarchian E.
Materikin A.
Epishev R.
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Voprosy Sovremennoi Pediatrii - Current Pediatrics |
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© 2018 Publishing House of the Union of Pediatricians. All rights reserved. Atopic dermatitis is a common chronic inflammatory skin disease characterized by a recurring course and progressive decrease in the quality of life. Recent studies in this area demonstrate the multifaceted pathogenesis of atopic dermatitis. Interaction of such factors as epidermal dysfunction, immune system disorders, and the consequences of genetic mutations contributes not only to the development of the disease but also to its progression and chronic course. The article presents various components of the etiopathogenesis of atopic dermatitis, describes the role of lipids, thereby the new therapeutic targets are revealed to specialists.
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Analysis of the factors that prevent adherence to treatment in patients with diabetes mellitus and the strategies that contribute to the improvement in adherence
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01.01.2018 |
Likhodey N.
Kalashnikova M.
Likhodey E.
Fadeyev V.
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Diabetes Mellitus |
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© Russian Association of Endocrinologists, 2018. This review examined the current problem of low adherence to treatment in patients with chronic diseases, particularly type 2 diabetes mellitus. According to the definition of the World Health Organization, 'adherence to treatment' is the degree to which a patient's behaviour corresponds to the doctor's recommendations with respect to medications and implementation of dietary advice and/or lifestyle changes. The current medical literature includes a large number of scientific publications devoted to the study of various factors that lead to low adherence to treatment. The term 'barriers' is most often used to designate these factors. The first part of this work contains an analysis of the main factors that impede compliance to the doctor's recommendations, such as socioeconomic and psychological (personal) barriers related to the disease itself, the peculiarities of its treatment and the organisation of medical care (the health care system). The second part of this review examines the different theoretical models of patient behaviour and strategies that improve adherence to treatment. Most researchers believe that there is an unsatisfactory (low) adherence to treatment and that none of the existing intervention strategies can improve adherence to treatment among all patients. The cornerstone of the entire diabetes management system is the training of patients within the framework of developed structured programmes. Conversely, success depends on the individual approach, the course of the disease and the mandatory consideration of the individual psychological characteristics of each person. Establishment of a partnership built on trust between a doctor and a patient contributes to greater patient satisfaction with treatment and improved adherence, and this relationship ultimately affects the treatment efficacy and clinical outcomes.
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Management of bleedings and recurrent venous thromboembolism in patients receiving Vitamin K antagonists
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01.01.2018 |
Krylov A.
Shulutko A.
Petrovskaya A.
Prasolov N.
Khmyrova S.
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Flebologiya |
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© 2018 Media Sphera Publishing Group. All Rights Reserved. Aim - the objective of the present work was to analyze the data obtained in a study involving a group of patients presenting with recurrent deep vein thrombosis and/or bleeding who had been treated with the use of vitamin K antagonists. Material and methods. A total of 116 patients presenting either with recurrent deep vein thrombosis (n=10) or bleeding that developed while patients had been on the therapy with vitamin K antagonists were enrolled in the study. We performed clinical and instrumental examination as well as laboratory testing of the hemostatic system. All the patients received warfarin during 6 months or longer with 32 of them taking this medication to prevent deep vein thrombosis and the remaining 84 for the treatment of various cardiac diseases. The results of the clinical, instrumental, and laboratory studies provided a basis for the choice of the treatment strategies. Results. Sixty seven of the 116 patients were treated non-surgically while 27 patients were operated (25 urgently and two within 2 days after the admission to the hospital). 20 patients underwent endoscopic hemostasis, in two others the hematoma was punctured under ultrasound guidance. Eight patients presenting with recurrent deep vein thrombosis received the conservative treatment reduced to the correction of anticoagulation therapy (they were first switched from warfarin to heparins with the subsequent resumption of warfarin treatment using the individually adjusted doses of the drug). Two patients with free-floating thrombi in the main veins required the surgical intervention to prevent pulmonary embolism. The conservative treatment of the patients with bleedings included the withdrawal of warfarin together with the simultaneous administration of vitamin K1, fresh frozen plasma, and prothrombin complex concentrate in different combinations taking into consideration the results of clinical examination and laboratory testing. The conservative treatment was successful in all the cases. No severe complications, life-threatening conditions or death were documented. Conclusion. The patients receiving vitamin K antagonists are at enhanced risk of both a relapse of venous thromboembolism and bleedings. The timely started and appropriate management can prevent the severe complications.
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