Extrapontine myelinolysis developed after aneurysmal subarachnoid hemorrhage (a case report and literature review).

Topicality: Central pontine and extrapontine myelinolysis is a rare and dangerous form of the demyelinating process of undefined origin, the development of which is associated with a very low sodium level in the blood (hypernatremia).

Objective: To describe a rare case of extrapontine myelinolysis as a complication occurring in the hemorrhagic period of anterior communicating artery aneurysm rupture as well as to demonstrate that this condition can be diagnosed intravitally.

Conclusion: Clinical vigilance of extrapontine myelinolysis may promote the timely diagnosis and treatment of this disease, which is a potential cause of death.

[N-TERMINAL PRO-BRAIN NATRIURETIC PEPTIDE AS BIOMARKER OF ACUTE BRAIN INJURY].

Laboratory diagnostic is very important in treatment of acute brain injury, together with neurophysiology and neurovisualisation methods. Biomarkers measurements can provide early brain injury diagnostic, monitoring of treatment as well as outcome prediction. We studied dynamic of N-terminal pro-brain natriuretic peptide (n-proBNP) level in patients with acute brain injury (intracranial hemorrage, traumatic brain injury, tumors).

[VEGETATIVE REACTIONS AS PROGNOSTIC FACTOR IN POSTERIOR FOSSA SURGERY].

Mortality rate related to posterior fossa tumors resection varies from 1 to 8 percent, according to various authors. It depends on tumor size and its growth characteristics. To determine the physiological acceptability of surgery, physiological significance of vegetative reactions associated with tumors resection has to be assessed.

[Neurovegetative stabilization as a pathogenetic therapy for brain damage].

The article deals with neurovegetative stabilization as a pathogenetic therapy for brain damage. The approach is based on hypothesis that pharmacological effecting on central nervous system is able to make a passive protective medical system which can be close to passive protective systems widely represented in the nature. Complex opioid and clonidine administration provides sufficient level of neurovegetative stability on account of effecting on neuro-regulative structures the brain steam.

[Modeling of different degrees of microvessel laser-induced endothelium damage].

A comparative analysis of rat mesentery micro vascular reactions on thermal impact during radiation to the focused laser irradiation in UV and visible regions of spectrum is made. Local intravascular temperature rise during laser irradiation both impulse (lambda = 337 nm) and continuous (lambda = 532 nm) states causes thrombus formation. The thrombus development that determined by laser irradiation parameters gives a possibility to modulate different degrees of microvessel endothelium damage.

[The application of the tracheostomy technique in neuroresuscitation].

The objective of the present study was to compare the frequency of complications associated with percutaneous dilatational tracheostomy by the method of Griggs and conventional surgical tracheostomy. The retrospective analysis of 120 critically ill patients maintained by mechanical ventilation and neurorehabilitated following tracheostomies was carried out. The two groups of the patients were matched for the age and severity of their clinical conditions.

[Thymectomy and antibodies to acetylcholine receptors (AChR) in patients with myasthenia gravis in the early postoperative period].

Thymectomy and removal of the hyperplastic thymus have been performed in 21 patients with myasthenia. In 14 patients, thymectomy is performed through thoracoscopic access (TA), while in 7 cases through thoracotomic access (TT). The serum levels of antibodies to acetylcholine receptors (AChR) determined before and after surgery were increased in both groups of patients.

[Prognostic criteria for tracheostomy in the neuroresuscitation unit].

Unlabelled: The aim is to specify prognostic criteria for tracheostomy on the basis of long-term (more than 14 days) ALV and prolonged (more than 14 days) trachea canmulation.

Materials And Methods: Retrospectively were analyzed the medical history of 120 difficult patients with tracheostomy, who spent in ICU more than 72 hours. Was executed multiple logistic regression analysis.

[Using of tranexamic acid (Tranexam) for prevention and correction of coagulopathy during brain tumors removal].

The aim of the study is to estimate clinical effectiveness of fibrinolysis inhibitor Tranexam in neurosurgical patients with intracranial tumors. The medication was prescribed to 78 patients from 27 to 65 years old. The control group consisted of 57 patients.

[Systemic inflammation complication of acute coronary syndrome with diabetes mellitua type 2].

The basic indicators of systemic inflammatory reaction syndrome, as well as the dynamics of the content of low and medium molecular weight glycopeptides and in biological media in patients with acute coronary syndrome. Analysis of the results showed that the presence of background type 2 diabetes mellitus in patients with acute coronary syndrome is associated with higher non-infective resorbtion of necrotic syndrome. This is the rationale for inclusion in the complex intensive therapy of more active desintocsication activities and metabolically significant effects on myocarde and for type 2 diabetes with acute coronary syndrome.

[Specific features of anesthetic management of surgical treatment of malignant tumors of the skull base].

Neurosurgical interventions on the skull base including craniofacial block-resections were fulfilled on 36 patients aged from 16 through 73 years. Preoperative management of the patients was made mainly at the intensive therapy room. It included correction of water-electrolyte, protein metabolism, anemia.

[Centrogenic reactions and their prognostic value during surgeries for posterior cranial fossa tumors in children].

The purpose of the study was to define the parameters of intraoperative monitoring, which allowed the prediction of complications due to surgery for posterior cranial fossa in children and the planning postoperative treatment tactics. The hypnotic propofol and a combination of the narcotic analgesic fentanyl and alpha 2-adrenoblocker clofelin were used to induce and maintain anesthesia. All patients were operated on in the sitting position.

[Efficacy of ivabradine in combination therapy for complicated acute coronary syndrome in patients with type 2 diabetes mellitus].

Aim: To study the effect of ivabradine (coraxan, Servier) as part of combination therapy on the clinical manifestations of acute left ventricular failure (ALVF) in Braunwald class II-IIIB unstable angina in patients with type 2 diabetes mellitus (T2DM).

Subjects And Methods: Thirty-six T2DM patients (mean age 56 + 4.3 years) with a diagnosis of acute coronary syndrome were examined.

[Intraoperative monitoring and its practical value in operations for tumors of the posterior cranial fossa in children].

The work is based on an analysis of the course of anesthetic aid, operative and early postoperative period in 62 patients aged from 15 months to 18 years with tumors of the posterior cranial fossa. The analysis concerned changes to the indices of systemic hemodynamics, findings of electrophysiological monitoring (electroencephalogram, acoustic stem induced potentials) and their interrelation with the outcomes of surgery. It was found that permanent disturbance of the heart rate such as bradycardia and tachycardia as well as the decreased indices of latency of peaks of the acoustic stem induced potentials and inter-peak intervals registered at the stage of removal of tumors of the posterior cranial fossa must be taken into consideration in the estimation of indications to medicinal narcosis in the postoperative period.

[Infectious safety in neurosurgical patients. The specific features of infectious complications in patients with subtentorial tumors, their diagnosis and treatment].

The paper analyzes the incidence of the major infectious complications (regional and systemic) developing in neurosurgical patients (3630 patients with neurosurgical diseases and 872 with abnormalities of the posterior cranial fossa (PCF)) in the postoperative period after removal of subtentorial tumors. Regional pyoseptic complications are shown to occur in patients with PCF abnormalities three times more frequently. The basic diagnostic and therapeutic approaches to pyoseptic complications in neurosurgical patients are also considered.

[Changes of hemo- and liquor-dynamics during intravascular interventions on venous-arterial malformations of the brain].

Changes in the arterial and venous blood flow and liquor-dynamics during intravascular venous-arterial interventions were studied in 30 patients with venous-arterial malformations of the brain. It was found that against the background of reduced venous-arterial shunting no expected drop of pressure in the jugular veins occured. Data were obtained on possible active autoregulation of pressure by the jugular veins.

[Using solutions of hydroxyethyl starch (6% HES 200/0.5 (refortan) and 6% HES 130/0.4 (voluven)) in neuroanesthesiology].

The paper provides the results of a complex experimental and clinical study of the effects of infusion solutions of hydroxyethyl starch (HES 200/0.5--Refortan and HES 130/0.4--Voluven) on hemostatic and systemic hemodynamic parameters in patients operated on for neurosurgical pathology of the brain.

[Use of amantadine sulfate (PK-MERZ) during emergence from coma: results of a multicenter study].

The paper gives the results of the first multicenter study of the efficiency of using amantadine sulfate (PK-Merz) in patients with acute cerebral disease during coma emergence. The study has shown a positive effect of this drug at coma emergence, which manifested itself as clinical improvement and a better outcome of the disease. Full objectivism of the findings requires further studies.

[The types and clinical significance of centrogenic reactions occurring during removal of tumors of the posterior cranial fossa].

Specific reactions, the so-called centrogenic reactions or short reflexes, occur in patients when intracranial tumors of the posterior cranial fossa are removed. The authors divide centrogenic reactions into two major groups: types 1 and 2 reactions. The study was based on the analysis of 110 case histories of posterior cranial fossa tumors that were at the extracerebral site.

[Experience with using of solutions of hydroxyethyl starch (refortan and voluven) in neuroanesthesiology].

The investigation has shown that solutions of hydroxyethyl starch included in complex infusion therapy facilitate stabilization of hemodynamics in neurosurgical patients during surgery. Refortan exerts a more pronounced effect on the indices of hemodynamics as compared with voluven, but its modifying action on the hemostasis system is also more pronounced. These medicines used in doses 6-8 ml/kg fail to have substantial effects on efficiency of hemostasis in the brain wound and do not increase risk of postoperative hemorrhagic complications.

[Infectious complications after brain tumor removal: some aspects of their prevention, diagnosis, and treatment].

A hundred and fifty-five case histories of neurosurgical patients with the complicated early postoperative period were analyzed. Early postoperative regional pyoinflammatory complications were developed in 21 (4.4%) of 481 patients.