[Chronic pelvic pain syndrome in women: diagnostic and therapeutic aspects].

Chronic pelvic pain syndrome (PPS) refers to pain of three to six months duration (or longer) that occurs below the umbilicus. PPS is considered a form of chronic regional pain syndrome or functional somatic pain syndrome. Multimodal ollaborative and patient-centered approach is critical component of treatment for women with CPPS. The current review encompasses the linical manifestations and therapeutic interventions for CPPS - a yet to be defined problem.

[STROKE: INCIDENCE AND RISK FACTORS FOR VENOUS THROMBOEMBOLIC COMPLICATIONS IN INTENSIVE CARE UNIT].

AIM: To study the evidence of venous thromboembolic complications (VTE (acute venous thrombosis (DVT) and pulmonary embolism (PE)) at the background of modern prevention for different characteristics and localization of stroke, as well as defining the role of the main clinical risk factors in the pathogenesis for ITE in stroke patients in intensive care unit. MATERIAL AND METHODS: The study included 123 patients with different types, localization and severity of stroke. All patients received standard prophylaxis VTE with low molecular weight heparin (LMWH). Neurological status, the severity of the general condition, the main clinical risk factors of stroke were assessed when income and in dynamics. There was planned duplex scanning of the veins of the inferior vena cava performed. RESULTS AND DISCUSSION: In spite of the application of modern preventive measures VTE, their frequency remains high accounting for 56%. All patients have a place DVT, in 26% of pulmonary embolism occurs. Groups at highest risk of VTE are patients with stroke more than 8 points of NIHSS, who are ventilated and assessed infection-inflammatory disorders, especially pulmonary. This group is considered to be at the highest risk of VTE. Modern preventive strategy for them is not sufficient and needs for the search of other preventive approaches.

[Herpes zoster-induced neuralgia (neuropathy)].

Neuralgia (neuropathy) is the most common manifestation of herpes zoster (HZ). In spinal and cranial neuralgia, there are 3 types of pain: 1) spontaneous, persistent, burning pain; 2) intermittent sharp pain; 3) pain occurring with nonpainful stimulation. The skin exhibits areas of hypesthesia, anesthesia, and dysesthesia. Ophthalmic neuralgia (of the first branch of the trigeminal nerve) is encountered in 20% of HZ cases. HZ of the auricle and external auditory meatus concurrent with facial and vestibulocochlear neuropathy is diagnosed as Ramsay Hunt syndrome. Postherpetic neuralgia (neuropathy) is characterized by pain present for 3 months or more after the appearance of herpetic eruptions. Combined therapy involving the earlier use of antiviral agents, tricyclic antidepressants, analgesics, and neuromidine is the most effective option for HZ-induced neuralgia (neuropathy).

Effects of carnosine on polyamine levels in red blood cells of patients with hypertonic discirculatory encephalopathy.

The levels of polyamines (putrescine, spermine, spermidine) in erythrocytes from patients with hypertonic discirculatory encephalopathy are reduced (by 37, 45, and 50%, respectively) in comparison with the corresponding parameters in the control group. Addition of carnosine to the treatment protocol for chronic brain ischemia normalized the content of putrescine and spermine. The mechanisms of carnosine influence on polyamine metabolism are discussed: trapping of acrolein, end-product of polyamine oxidation, and compensation of NMDA-receptor excitotoxicity.

[Risk factors associated with the development of the main subtypes of ischemic stroke in men aged 45 to 74 years]. / Faktory riska, svyazannye s razvitiem osnovnykh podtipov ishemicheskogo insul'ta, u muzhchin v vozraste ot 45 do 74 let.

OBJECTIVE: To identify risk factors associated with the development of the main subtypes of IS in men aged 45 to 74 years. MATERIAL AND METHODS: The study included 380 men, aged 45 to 74 years, including 247 inpatients with a diagnosis of IS in the area of the carotid artery (main group) and 133 patients with a diagnosis of chronic cerebral ischemia, stage I-II (comparison group). To build multivariate predictive models to assess the influence of risk factors on the development of the main subtypes of IS, the method of logistic regression with stepwise exclusion of variables according to the Wald algorithm was used. RESULTS: A prognostic model of atherothrombotic stroke revealed that the history of TIA increases the risk of stroke by 14.2 times (OR=14.222; 95% CI [2.911-69.497], p=0.001), atherostenosis of the internal carotid arteries by 13.2 times (OR=13.216; 95% CI [3.092-56.493], p<0.001), an increase in the degree of hypertension by one unit increases the risk of stroke by more than 5 times (OR=5.755; 95% CI [3.326-9.958], p<0.001). When constructing a prognostic model for the development of cardiogenic embolic stroke, it is shown that atrial fibrillation increases the risk of stroke by more than 22 times (OR=22.572; 95% CI [7.061-72.163], p<0.001), the of history TIA by 16.3 times (OR=16.329; 95% CI [1.678-158.862], p=0.016), coronary artery disease by more than 3 times (OR=3.662; 95% CI for [1.159-11.571], p=0.027), an increase in the degree of hypertension by one unit increases the risk of stroke by more than 3 times (OR=3.955; 95% CI [2.228-7.021], p<0.001). When constructing a prognostic model for the development of lacunar stroke, it is shown that an increase in the degree of hypertension by one unit and the history of IS increase the risk of stroke by more than 7 times (OR=7.637; 95% CI [4.092-14.251], p<0.001) and (OR=7.183; 95% CI [1.118-46.137], p=0.038), respectively. CONCLUSION: Differences in the significance of risk factors between groups of patients with the main subtypes of IS were revealed.

[Current opportunities for secondary prevention of atherothrombotic stroke]. / Sovremennye vozmozhnosti vtorichnoi profilaktiki aterotromboticheskogo insul'ta.

The article is devoted to an urgent medical and social problem - secondary prevention of atherothrombotic stroke and contains current evidence on the use of combined antiplatelet and anticoagulant therapy. In the COMPASS study, the dual-pathway thrombosis inhibition scheme using rivaroxaban in combination with acetylsalicylic acid (ASA) compared with ASA monotherapy demonstrated in patients with established atherosclerotic diseases of the circulatory system, a decrease in the total risk of stroke, death from cardiovascular causes and myocardial infarction by 24%; reduced risk of recurrent stroke by 67%. The incidence of repeated ischemic stroke (IS) in the combination therapy group was 1.1% per year, in the ASA group - 3.4% per year. The total incidence of adverse outcomes included in the combined indicator «net clinical benefit¼ in the rivaroxaban group in combination with ASA was 20% lower than in the ASA group and confirms the advantages of combination therapy in the prevention of recurrent noncardioembolic IS.

[Thrombosis and anatomic variants of intracranial dural venous sinuses]. / Tromboz i varianty stroeniya sinusov tverdoi mozgovoi obolochki.

A rather large number of different anatomic variants of intracranial dural venous sinuses are known, and they are found so often that interpreting them only as anomalies is unlikely, except for variations such as sinus aplasia or doubling, which can be attributed to anomalies of the venous system. Diameter reduction (hypoplasia) of the transverse and sigmoid sinuses is observed relatively often. In cases of dural sinuses anomalies, sinuses on the contralateral side are necessarily evaluated as the main source of compensation. When diagnosing dural sinus thrombosis, it is necessary to have a clear idea of the structure of the cerebral venous system, so as not to mistakenly accept hypoplasia or sinus aplasia for thrombosis. Our own experience is based on the results of a neuroimaging study of cerebral veins and venous sinuses in 103 patients (average age 35±10 years) with a tension-type headache. Hypoplasia of the transverse and sigmoid sinuses was detected in 21 (22.4%) cases. In 10 cases (6 men, 4 women), a connection was established between hypoplasia of the dural sinuses and thrombosis. Four patients, presented with hypoplasia of the right transverse and sigmoid sinuses and 6 patients with hypoplasia of the left transverse and sigmoid sinuses. Thrombosis developed on the side of sinus hypoplasia (9 patients) or on the contralateral side (1 patient). Early diagnosis of cerebral venous thrombosis is crucial because the use of anticoagulants reduces the risk of a poor prognosis, severe disability without an additional increase in the risk of brain hematomas progression.

[Chronic cerebrovascular diseases and neuroprotection: the clinical efficacy of meldonium (Mildronat)]. / Khronicheskie formy narushenii mozgovogo krovoobrashcheniya i neiroprotektsiya: klinicheskaya effektivnost' primeneniya mel'doniya (Mildronat).

OBJECTIVE: To evaluate the efficacy of meldonium (mildronat) in patients with chronic cerebral vascular disease (CVD). MATERIAL AND METHODS: An open comparative study of the clinical efficacy of meldonium (mildronat) in patients with chronic CVD caused by arterial hypertension and atherosclerosis was conducted. The main group included 30 (60%) patients who were prescribed meldonium (mildronat) at a dose of 1000 mg per day in addition to routine basic therapy. The control group was consisted of 20 (40%) patients who received routine basic therapy only. The duration of the study was 60 days. To evaluate the clinical efficacy of the meldonium (mildronat), the main subjective clinical symptoms, neurological, psychoemotional and cognitive status, quality of life were assessed when patients were included in the study (before treatment), on the 11th and 60th days from the start of treatment. To assess the meldonium (mildronat) effect on the endothelium vascular wall, asymmetric dimethylarginine (ADMA), tissue plasminogen activator (tPA), plasminogen activator inhibitor-1 (PAI-1) and endothelin-1 were determined in the blood when patients were included in the study, on the 11th and 60th days from the start of treatment. RESULTS: Meldonium (mildronat) has a positive therapeutic effect on the main clinical symptoms and cognitive functions which appears in increasing the quickness of mental activity, improving short-term and operative memory, increasing the resistance of mental processes and memory traces to interfering influences, and improving cognitive evoked potentials P300 results. Meldonium (mildronat) therapy leads to the decrease in the level of state and trait anxiety. The quality of life of patients treated with meldonium (mildronat) increases due to the physical and mental components. The effect of meldonium (mildronat) on the decrease in endothelin-1 and PAI-1 levels, which indicates the antitrombogenic effect of the drug, has been identified. CONCLUSION: Nootropic, anxiolytic and antitrombogenic effects of meldonium (mildronat) in patients with chronic CVD are demonstrated that makes it possible to recommend this drug for widespread use by specialists in clinical practice.

[Aminothiols in blood plasma at different subtypes of ischemic stroke]. / Aminotioly plazmy krovi pri razlichnykh podtipakh ishemicheskogo insul'ta.

OBJECTIVE: To evaluate the hemostasis of plasma aminothiols in different subtypes of ischemic stroke (IS). MATERIAL AND METHODS: The study included 177 patients, aged 62 (55-68) years, admitted in the first 8-24 hours since IS onset. The pathogenetic subtype of IS was clarified according to the results of clinical and instrumental examination by the Trial of ORG 10172 in Acute Stroke Treatment criteria. Determination of the total plasma aminothiols levels, their reduced forms and redox status was performed using the ultra-efficient Acquity H-Class UPLC liquid chromatograph (Waters, CSHA). RESULTS: Large-artery atherosclerosis was diagnosed in 24.3% patients, cardioembolic stroke in 20.3%, lacunar stroke in 55.4%. Significant differences in total levels of cysteine (Cys), glutathione (Gsh) and homocysteine (Hcy) were identified in patients with different IS subtypes. Patients with large-artery atherosclerosis and lacunar stroke showed the highest level of Hcy, patients with cardioembolic stroke had the lowest levels of Cys and Gsh. CONCLUSION: Total levels of plasma aminothiols are associated with different subtypes of IS.

[Gender differences in stroke risk factors]. / Gendernye osobennosti otdel'nykh faktorov riska razvitiia narushenii mozgovogo krovoobrashcheniia.

Currently, there are a lot of studies on gender-related risk factors for stroke. However, contradictory data and the lack of a common view on the problem of gender-based approach to stroke prevention determine the importance of this problem. The most significant sex-non-specific stroke risk factors are hypertension, cardiac conditions, including atrial fibrillation, smoking, glucose and lipid metabolism disorders, excessive alcohol consumption, overweight, low physical activity and sedentary lifestyle, emotional stress. However, the incidence and significance of each stroke risk factor in women are different compared with men, due to women's reproductive status. Hypertension, atrial fibrillation, diabetes mellitus, abdominal obesity, migraine with aura, emotional stress and depression are more common risk factors in women compared to men. The stroke risk factors unique to women are the timing of age at menarche, pregnancy, gestational diabetes mellitus, preeclampsia, hormonal status disturbances, the use of combined oral contraceptives and hormone replacement therapy.

[Lacunar stroke]. / Lakunarnyi insul't.

Lacunar stroke occupies a special place among the various subtypes of ischemic stroke, accounting for about 25% in its structure and pathogenetically most often associated with cerebral microangiopathy caused by arterial hypertension (AH) and stenotic tandem atherosclerosis (AS) of cerebral arteries. Small deep (lacunar) infarction (SDI) of the brain is its structural basis. In recent years, understanding of its heterogeneous pathogenesis, clinical and practical significance was significantly expanded in connection with the widespread introduction into practice of highly informative neuroimaging methods (first of all, the newest MRI methods), which make it possible to identify SDI of the brain at various stages of their development, including in the acute period of lacunar stroke. This review covers in the historical aspect the issues of morphology, pathogenesis, clinical and neuroimaging dynamics of hypertensive and atherosclerotic SDI, including the criteria for their differential diagnosis. Particular attention is paid to the problems of asymptomatic ('silent') SDI, which, according to recent research, along with the diffuse pathology of the cerebral white matter, make a large contribution to the development of cognitive impairment up to the development of vascular dementia, and also are predictors of severe hemorrhagic and ischemic stroke in patients with AH and AS.

[Clinical presentations, diagnosis and treatment of cerebral vein and sinus thrombosis]. / Klinika, diagnostika i lechenie tromboza mozgovykh ven i venoznykh sinusov.

The problem of thrombosis of cerebral veins and venous sinuses is insufficiently studied. The real incidence of cerebral venous thrombosis remains incompletely defined. The article presents results of clinical research on cerebral vein and sinus thrombosis, which served as a ground for an analysis of causes and development of the disease. In 20-35% of patients with cerebral venous thrombosis, this disease remains idiopathic after extensive investigation. Particular attention is given to risk factors, clinical presentations, early diagnosis, treatment, prognosis of cerebral vein and sinus thrombosis.

[Neurophysiological assessment of persistent idiopathic facial pain]. / Neirofiziologicheskaia otsenka persistiruiushchei idiopaticheskoi litsevoi boli.

AIM: To study neurophysiological characteristics of persistent idiopathic facial pain (PIFP) in comparison to trigeminal neuralgia. MATERIAL AND METHODS: Forty-five patients with PIFP at the age from 25 to 74 years (42 women and 3 men), 25 patients with trigeminal neuralgia at the age from 25 to 84 (15 women and 10 men) and 20 healthy volunteers were examined. Multimodal evoked potentials (EP): brainstem auditory (BAEPs), trigeminal (TEPs) and sympathetic skin responses (SSRs) evoked potentials were recorded. EEG with functional tests (hyperventilation, rhythmical photic stimulation and test with eye opening) was recorded as well. RESULTS: The neurophysiological pattern of PIFP includes: 1) shortening of the latent period (LP) and an increase in peak amplitudes of short-latent components of the BAEPs on both sides in combination with signs of brainstem structure dysfunction (fusion of II-III or III-IV peaks, bifurcation of peaks and lengthening of inter-peaks intervals); 2) normal parameters of the TEPs; 3) an increase in the amplitude of autonomic components (sympathetic and parasympathetic without signs of predominance of the tone of this or that system), intensification of the autonomic reaction; 4) disorganization and acuity of the alpha rhythm, smoothing of zonal differences, presence of bilateral tapering alpha-, theta- or alpha-theta waves on the EEG. CONCLUSION: Patients with PIFP have significant changes in EP and EEG connected with brainstem structure dysfunction and irritation of subcortical structures and autonomic disorders.

[Intimal rupture of the displastic middle cerebral artery wall complicated by thrombosis and fatal ischemic stroke]. / Razryv intimy pri displazii stenki srednei mozgovoi arterii, oslozhnivshiisia trombozom i razvitiem tiazhelogo ishemicheskogo insul'ta.

The authors present a clinical-morphological observation of the 47-year old man with a severe fatal ischemic stroke due to middle cerebral artery thrombosis which developed at the site of intimal rupture. The cause of intimal rupture was the arterial wall dysplastic changes. There were no signs of atherosclerosis and hypercoagulation. As the intima rupture did not lead to blood input into arterial wall, but was accompanied by superimposed thrombosis, we suggested to denote such cases as incomplete dissection.

[Medication overuse headache]. / Abuzusnaia golovnaia bol'.

Rebound headache (RH) is a chronic daily headache which occurs when analgesics, triptans, ergotamines are taken frequently (more than 15 days/month for more than 3 months) to relieve headaches. The prevalence of RH is 1 to 4% in the general population. RH commonly occurs in patients with migraine and tension-type headache. The deficit of central sensitization and psychological factors play an important role in initiating and maintaining of RH. Treatment of noofen for 2 months is effective in 75% of patients with RH.

[Brainstem auditory evoked potentials in neurophysiological assessment of brain stem dysfunction in patients with atherostenosis of vertebral arteries]. / Akusticheskie stvolovye vyzvannye potentsialy v neirofiziologicheskoi otsenke disfunktsii stvola mozga u patsientov s aterostenozom pozvonochnykh arterii.

AIM: To assess brain stem dysfunction in patients with hemodynamically significant stenosis of vertebral arteries (VA) using short latency brainstem auditory evoked potentials (BAEP). MATERIAL AND METHODS: The study group included 50 patients (mean age 64±6 years) with hemodynamically significant extracranial VA stenosis. RESULTS: Patients with hemodynamically significant extracranial VA stenosis had BAEP abnormalities including the elongation of interpeak intervals I-V and peak V latency as well as the reduction of peak I amplitude. After transluminal balloon angioplasty with stenting of VA stenoses, there was a shortening of peak V latency compared to the preoperative period that reflected the improvement of brain stem conductive functions. CONCLUSION: Atherostenosis of vertebral arteries is characterized by the signs of brain stem dysfunction, predominantly in the pontomesencephal brain stem. After transluminal balloon angioplasty with stenting of VA, the improvement of brain stem conductive functions was observed.

[Complex assessment of the contribution of genetic factors to the risk of ischemic stroke]. / Kompleksnaia otsenka vklada geneticheskikh faktorov v razvitie ishemicheskogo insul'ta.

AIM: To develop a method of the complex assessment of genetic risk for ischemic stroke (IS) and evaluate its effectiveness. MATERIAL AND METHODS: Genotyping of 182 patients with atherothrombotic and cardioembolic subtypes of IS and 360 healthy individuals of 48 single nucleotide polymorphic loci (SNP) associated with the risk of II and its subtypes was performed. RESULTS AND CONCLUSION: In each group of SNPs, composite indicators of genetic risk of IS in groups of patients and healthy controls were identified. Differences between the calculated values of the genetic risk in these groups were significant (p <0,05). The quality of the binary classification validated by ROC-analysis confirmed the predictive potential of the proposed method of risk calculation for determining the genetic predisposition to the development of IS.