Vol 19, No 2-2 (2017)

Objective of the study - to detect diagnostic criteria for chronic brain ischemia based on analysis of electrokinetic properties of peripheral erythrocytes. Materials and methods. Material for the study was based on the erythrocytes of venous blood 95 patients with chronic brain ischemia, the reference group consisted of 54 healthy donors. To perform electrophoretic cell analysis of erythrocytes was used the shorthand method of computer microelectrophoresis. Results. Data analysis revealed with the increasing severity of the disease increased the share of fixed erythrocytes, decreased the electrophoretic mobility of cells and decreased the heterogeneity of the analyzed populations in the amplitude oscillations of erythrocytes. When analyzing the thickness of the intima-media complex, it was found that with the progression of the atherosclerotic process the rate of movement of erythrocytes in the electric field also decreases. Conclusion. Thus, indicators of the electrokinetic activity of erythrocytes (the share of fixed erythrocytes, the average amplitude of their vibrations and its deviation, electrophoretic mobility and its deviation) can serve as criteria for the severity of chronic brain ischemia.

The aim of the study was to study endothelial function in patients with chronic cerebral ischemia in atherosclerotic stenosis of the internal carotid arteries (ICA). Materials and methods. A total of 69 patients were examined. Evaluation of the function of the endothelium was carried out using the photoplethysmographic method by the non-invasive diagnostic complex AngioScan-01 (Fiton). Along with this, a study was made of molecules of intercellular adhesion of VCAM and E-selectin. Results. Progression of neurological symptoms was revealed as the degree of stenosis of the internal carotid arteries increased, which was reflected in an increase in disorders of cranial nerves, motor, sensitive and autonomic systems. The increase in neurologic symptoms was accompanied by a decrease in the visco-elastic properties of the aorta, increased stiffness of large arteries, increased tonus of small resistive arteries and dysfunction of the endothelium in large and small muscle arteries. The highest values of E-selectin and vCAM were observed in patients with atherosclerotic lesions of the internal carotid arteries up to 30%. Conclusion. Violation of endothelial function in small resistive and in large conductive arteries is observed in patients with different degrees of stenosis of the ICA, starting with stenoses up to 30%. The processes of vascular inflammation are most pronounced at the initial stages of atherosclerotic stenosis of the ICA.

In neurological clinic, there are difficulties in differential diagnosis of speech disorders, which are similar to the aphasia syndrome, but are not the true aphasia. They are provoked by different groups of diseases: conversion neurotic disorder, mental disorders, dementia, etc. Systemic practical observation of these forms of speech pathologies made it possible to determine the characteristic signs of false aphasias: 1) absence of the primary (starting) mechanism; 2) gradual development of speech disorders; 3) fluctuation of symptoms; 4) violation of non-verbal contact; 5) Variable changes in the structure of the personality as a whole.

Diabetes mellittus leads to different disorders of peripheral nervous system, but the most prevalent one is chronic predominantly sensory symmetrical distal polyneuropathy. It is developed in 30-50% of patients and significantly decreases quality of life because of neuropathic pain, other unpleasant sensations and autonomic insufficiency. Appropriate metabolic control decrease the risk of neuropathy development especially in diabettismellittis type 1. Antioxidant therapy with a-lipoic acid is also proven from pathogenetic position and had shown efficacy with regard to diminish of neurological symptoms. Symptomatic therapy of neuropathic pain includes antidepressants and anticonvulsants.

Carpal tunnel syndrome (CTS) is of the most prevalent diseases of peripheral nervous system (86.7% of all tunnel syndromes). Despite this fact diagnosis and treatment of this pathology is a great challenge. The aim of the study was to optimize the diagnosis and treatment of CTS. Materials and methods. 126 patients with CTS were divided into 2 groups. Therapy of the main group (n=60) included basic scheme (local steroid injection - LSI, splinting, vitamins B, gabapentin) and cholinesterase inhibitor ipidacrine (Ipigrix®). Therapy of the control group (n=66) was limited by the basic scheme. The total duration of the observation period was 60 days. The effectiveness of treatment was evaluated according to the analysis of NRS, QuickDASH and nerve conduction studies’ (NCS) results. Results. The “flick sign” turned out to be the most specific (93.2%) and sensitive manifestation of CTS. Ipigrix administration allowed to significantly reduce (p<0.05) severity of sensory of motor disturbances, enhance physical function of the upper limb in patients of CTS which correlated with positive changes of NCS-parameters (predominantly in sensor fibers). We have also estimated the clinical prediction rules (CRPs): duration of CTS less than 3 mths, lack of severe thenar atrophy, amplitudes of recorded n. medianus motor response >5.5 ms, motor conduction velocity >51.6 m/s, total reduction of sensory disturbances after 1st LSI, ipidacrine administration. The presence of all 6 CRP’s predicts good effect of conservative treatment (lack of pain, QuickDASH≤10 points) in almost 90% of CTS patients. Conclusions. Verification of CTS should be based on diagnostic value of clinical signs and tests. Therapy of CTS must be regulate by CRP’s and indications for surgery. Ipidacrine (Ipigrix®) should be included in basic scheme of CTS conservative treatment.

9-11 февраля 2017 г. в Москве в рамках 13-й междисциплинарной конференции «Вейновские чтения» прошел симпозиум «Острая и хроническая боль: от симптома к осмыслению жизни пациента». Тема боли - одна из актуальных проблем современного общества: боль способна не только значительно менять качество жизни человека, в ряде случаев она способна лишить его жизни, борьба с ней приводит к существенным финансовым затратам. О причинах, механизмах развития и современных методах лечения боли шла речь в докладах симпозиума, прочитанных ведущими российскими экспертами: доктором медицинских наук, профессором Ан.Б.Даниловым, доктором медицинских наук, профессором А.В.Наумовым, доктором медицинских наук, профессором И.Г.Козловым, доктором медицинских наук, профессором Ал.Б.Даниловым.

The purpose of the work is to reveal the features of neuroethics and new contradictions that have arisen in modern neurosurgery in close connection with its technology. Material and methods. The literature on neuroethics, the 20-year experience of the authors and individual samples of neurosurgical patients with acute traumatic injuries (in particular, 170 patients with intracerebral hematomas and focal brain injuries) and chronic subdural hematomas (400 patients) were analyzed to identify ethical problems and their pathways solutions. Results. Systematized factors of humanization and dehumanization of neurosurgery. New contradictions have arisen due to the widespread use in neurosurgery of methods of neuroimaging: fetishization of visual data and ignoring the patient's clinic and personality; The abundance of sophisticated technologies and the lack of generalized concepts; The professional duty of the doctor and commercial temptations; The sanctity of life and the quality of life, and a number of others. It shows how dilemmas arise that are fraught with threats of atrophy of clinical thinking, hypokylia, and distancing the doctor from the patient. Conclusion. Resolution of contradictions in modern neurosurgery must be based on the interests of both the patient and society. This requires a combination of a highly professional neurosurgeon with a priority of ethical and humanitarian values at all stages of his training and activities.