[Paradoxical embolism in patients with ischemic stroke].

The present study included 84 patients with ischemic stroke of known and unknown etiology. The risk of paradoxical embolism (PE) was evaluated using contrast transthoracic echocardiography, contrast transcranial Doppler monitoring, and transoesophagal echocardiography. The majority 64%) of the patients with strokes of known etiology were found to be predisposed to PE because they had the patent interatrial foramen (PIF) and pulmonary shunt (51 and 13 respectively). PIF was of small functional and anatomical size. Predisposition to PE in most patients with cryptogenic stroke (94%) was due to the presence of PIF (in 88%) and was often the sole cause of the stroke. These patients frequently had the shunt of a large functional size.

[Functional evaluation of cerebral hemodynamics using transcranial dopplerography and nitroglycerin test in occlusion of the internal carotid artery]. / Funktsional'naia otsenka tserebral'noi gemodinamiki metodom transkranial'noi dopplerografii s ispol'zovaniem nitroglitserinovogo testa pri zakuporke vnutrennei sonno'i arterii.

42 patients with one-sided atherosclerotic occlusion of internal carotid artery (ICA) out of acute stage of stroke were examined by means of method of transcranial dopplerography with application of nitroglycerin test. Unstable course of the disease with development of repeated ischemic disorders of cerebral circulation were found in most of the patients with decreased hemodynamic reserves in homolateral hemisphere. Differences revealed were statistically significant. It was established by means of nitroglycerin test that the decrease of pike systolic linear rate of blood flow through the median cerebral artery on the side of ICA occlusion less than 10% was the sign of unstability of cerebral circulation and could serve as an indication for surgical correction of the circulation.

[Functional transcranial dopplerography in an atherosclerotic lesion of the carotid arteries]. / Funktsional'naia transkranial'naia dopplerografiia pri ateroskleroticheskom porazhenii sonnykh arterii.

Transcranial dopplerography (TDG) examination of the blood flow along the major intracranial arteries and cerebral vascular response to functional loads was performed in 51 patients with stenosis and/or occlusion of the internal carotid artery (ICA). The measurements were made on the equipment "Quantascope-103 PC" (Scimed, England). 74% (26 patients) of ICA occlusion subjects had asymmetry of the linear circulation rate (LCR) in the middle-size cerebral arteries (MCA). It occurred with LCR inhibition on the ipsilateral to the occlusion side. In half of ICA stenosis patients the ipsilateral MSA circulation was also reduced. The difference between the two groups in relation to MCA circulation asymmetry was significant (p < 0.001). Nitroglycerin and hypercapnia tests proved more informative than ortho- and antiorthostatic tests. A relationship was found out between overall stenosis of major brain arteries and blood flow along them.

[Lesions of the major arteries of the head (a population ultrasonic study)]. / Porazhenie magistral'nykh arterii golovy (populiatsionno-ul'trazvukovoe issledovanie).

The screening of the random sample from an open population of males aged 40-65 was performed to compare frequency and severity of hemodynamic changes in major head arteries (MHA) due to atherosclerosis in subjects with vascular diseases and clinically normal controls. 866 of the examinees were subjected to MHA ultrasonic dopplerography. Normal circulation appeared only in 13% of the examinees. The rest of them had insufficient circulation or at least one vessel affected with stenosis. The standard index of MHA stenosis amounted to 20.2%. The frequency of MHA stenosis was related to the age, vascular involvement and severity of the latter.

[Cerebrovascular disorders in various types of the subclavian steal syndrome]. / Narusheniia mozgovogo krovoobrashcheniia pri razlichnykh variantakh podkliuchichnogo stil-sindroma.

A total of 51 patients with the subclavian steal-syndrome (SSS) were examined for the clinical picture comparatively to the angiography and ultrasound dopplerography (USDG) data. The clinical manifestations of cerebral circulatory disorders were studied not only in the isolated SSS but also in its different variants realized in association with concomitant lesions of the other branches of the aortic arch. Rarely occurring variants of the SSS were revealed; some of them were discovered for the first time. The types of collateral circulation to compensate for arm blood supply in the SSS were specified using the authors' material. The studies have confirmed that USDG is a fairly informative method of diagnosing the SSS.

[Study of the volumetric blood flow velocity in the median cerebral artery using transcranial Doppler flowmetry and cerebral angiography]. / Issledovanie ob''emnoi skorosti krovotoka v srednei mozgovoi arterii s pomoshch'iu transkranial'noi dopplerografii i tserebral'- noi angiografii.

Transcranial dopplerography (TDG) and cerebral angiography (CA) were used to measure the volumetric rate of the blood flow (VRBF) in the median cerebral artery (MCA) in 47 patients suffering from different cerebrovascular diseases, with the internal carotid arteries (ICA) remaining unchanged (26 patients) or with insignificant changes in the ICA, not interfering with the blood flow (21 patients). The values of the mean diameter of the MCA (3.10 +/- 0.04 mm), the mean magnitude of the linear peak systolic rate of the blood flow (LPSRBF) in the MCA (71.63 +/- 17.39 cm/s), the mean VRBF in the MCA (179.49 +/- 64.51 ml/min) were derived. The ratio of the linear regression of the VRBF to the LPSRBF amounted to 3.26.

[Analysis of several methods of detection of biorhythms in chronodiagnosis and chronotherapy of cardiovascular diseases]. / Analiz nekotorykh metodov vyiavleniia bioritmov dlia khronodiagnostiki i khronoterapii serdechno-sosudistykh zabolevanii.

The paper analyses the characteristics of mathematical methods for detecting the biorhythms currently used for the chronodiagnosis and chronotherapy of cardiovascular diseases. Emphasis is laid on the assessment of the resolving power of algorithms and programs applied to the detection of circadian biological rhythms. The paper also discusses whether chronodiagnosis and chronotherapy of cardiovascular diseases are admissible by clinically available mathematical methods for detecting circadian rhythms. In addition, it deals with theoretical conditions required for accurate detection of varying frequency biological rhythms from length-limited data arrays and proposes a mathematical method suitable to a problem to detect biological rhythms with periods unknown in advance.

[Combined lesions of the major arteries of the head (clinico-doppleroangiographic correlations)]. / Sochetannye porazheniia magistral'nykh arterii golovy (kliniko-dopleroangiograficheskoe sopostavlenie).

Using Doppler ultrasonography (DUSG) under outpatient conditions multiple combined lesions of the main arteries of the head were found in 127 patients. Comparison of the above results with the findings of cerebral angiography showed a high efficiency of DUSG. In occlusion of the carotid and vertebral arteries the accuracy of the method was 99%, specificity 99%, sensitivity 100%; in stenoses of the internal carotid arteries the respective values were 88, 84, and 95%; in cases of all stenoses of the vertebral arteries they were 93, 92, and 94%. A comparative analysis of the clinical, Doppler and angiographic findings revealed that an increase in the frequency and degree of impairment of the main arteries of the head correlated with an elevated rate of cerebral circulation disorders in several vascular beds.

[Evaluation of the function of extracranial-intracranial microarterial anastomoses in occlusive diseases of the main arteries of the head (Doppler and angiographic study)]. / Otsenka funktsii ékstraintraktranial'nykh mikroarterial'nykh anastomozov pri okkliuziruiushchikh porazheniiakh magistral'nykh arterii golovy (doplero- i angiograficheskoe issledovanie).

The comparison of the results of Doppler and angiographic examinations of 82 patients with combined occlusive disorders of the major arteries of the head before and after creating an extra-intracranial microarterial bypass showed a high informative value of Doppler sonography as a noninvasive method of the diagnosis of impairments of the cerebral arteries and as a method of control of microarterial anastomosis functioning. Placement of a microanastomosis between the external carotid and middle cerebral arteries eliminated or reduced the steal-phenomenon in relation to the brain or vertebral-basilar bed in combined lesions of the major arteries of the head.

[Principle of organizational and technical unity in designing complex hardware for the processes in polyclinic care]. / Printsip organizatsionno-tekhnicheskogo edinstva v proektirovanii kompleksnogo tekhnicheskogo osnashcheniia protsessov poliklinicheskogo obsluzhivaniia.

A method to describe processes of health care in outpatient clinics is proposed. It produces necessary conditions for interactions between designers and users of medical complex hardware at the stage of the development.

[Ultrasound dopplerography in the diagnosis of the subclavian steal syndrome]. / Ul'trazvukovaia dopplerografiia v diagnostike sindroma podkliuchichnogo obkradyvaniia.

To diagnose occlusions in the brachiocephalic trunk and in the proximal portions of the subclavian artery in combination with the subclavian steal syndrome, a simple noninvasive method--Doppler sonography--has been used by the author since 1975. This technique consists in sequential registration of the blood flow rate along the vertebral and axillary arteries in combination with functional-compression tests including making a fist, rated physical exercise with a hand as well as compression of the brachial and vertebral arteries. Using Doppler ultrasonography, the subclavian steal syndrome was detected in 25 patients and in 24 cases the diagnosis was confirmed by angiography, this showing a 96% validity of this diagnostic procedure. Peculiar features of this technique as well as its potential wide application for diagnostic purposes in out- and in-patients with cerebrovascular diseases are discussed.

[Technic of ultrasonic dopplerography in the diagnosis of occlusive lesions of the arteries of the base of the brain (doppleroangiographic study)]. / Metod ul'trazvukovoi dopplerografii v diagnostike okkliuziruiushchikh porazhenii arterii osnovaniia mozga (doppleroangiograficheskoe issledovanie).

Use was made for the first time of the ultrasonic dopplerography method for diagnosing occlusions of the brain base arteries in patients with cerebrovascular diseases. For this purpose a functional-compression examination technique was developed that enabled one to evaluate indirectly the patency of the intracranial arteries. Dopplerographic criteria of occlusions of individual arteries were determined. A comparison of the diagnosis made with the use of the ultrasonic dopplerography with the data of subsequent cerebral angiography showed that the results coincided in 83.3% of occlusions in the basilar arteries; 90% of occlusions in the terminal parts of the vertebral arteries: 90% of occlusions in the anterior and posterior communicating arteries; 86% of occlusions of internal carotid arteries in the siphon region, and 80% of occlusion of the median cerebral arteries. The results obtained give one grounds to recommend the ultrasonic dopplerography for practical use as a simple and sufficiently reliable method for diagnosing occlusions of the brain basin arteries.