[Hemostatic disorders in neurosurgical patients: diagnostics and correction]. / Narusheniya sistemy gemostaza u neirokhirurgicheskikh bol'nykh: diagnostika i korrektsiya.

The authors analyzed the main causes of perioperative hemostatic disorders in neurosurgical patients. The problem of preoperative hemostatic screening, intraoperative and postoperative factors contributing to hemostatic disorders are considered. The authors also discuss the methods for correction of hemostatic disorders.

[Severe postoperative intracranial hemorrhagic complications in a neurosurgical patient with von Willebrand disease not diagnosed before surgery (a case report and literature review)]. / Tiazhelye posleoperatsionnye intrakranial'nye gemorragicheskie oslozhneniia u neirokhirurgicheskogo bol'nogo s ne diagnostirovannoi do operatsii bolezn'iu Villebranda (klinicheskoe nabliudenie i obzor literatury).

The article describes a rare clinical case of a patient with previously undiagnosed von Willebrand disease and basal meningioma; an intracranial neurosurgical intervention was complicated by delayed intracranial hematomas, both at the resected tumor site and distantly. The diagnosis of von Willebrand disease was established only after special hematology tests and only after surgery. Despite the use of specific therapy, the patient died due to intracranial hemorrhagic complications in the postoperative period. The paper discusses the problem of preoperative diagnosis of asymptomatic hemostasis disorders in neurosurgical patients and potential ways of its solution.

[Is there interrelationship between percentage of hemolysis and clots in samples of venous blood?].

The most failures in the process of laboratory analysis occur at the pre-analytical stage. The percentage of samples of blood serum with hemolysis and percentage of samples of EDTA of whole blood with clots are largely applied as indices of quality of venous blood sampling. The analysis of data from 28 laboratories established no relationship between percentage ofsamples with hemolysis and percentage of samples with clots. Prior to implementation of more large-scaled studies, the level less than 1% of samples with hemolysis can be accepted as a minimal level of quality of blood sampling and the level less than 0.4% of samples of total blood with clots can be accepted as a minimal level of quality ofpreparation of samples after blood drawing from vein for analysis using hematological analyzers. both indices can be applied for estimating efficiency of measures concerning amelioration of quality of procedure of blood drawing from vein. By all appearances, the ideal sample for control of quality of blood drawing in the nearest future can become sample of blood drew from vein into vial with citrate for analysis using modern coagulometric analyzer. This sample can become a source for calculation of several indices of quality of venous blood drawing (hemolysis, clots, vial filling and violation of ration sample-anticoagulant).

[Stress adaptive effects after traumatic brain injury]. / Vozmozhnosti realizatsii adaptivnykh éffektov stressa posle cherepno-mozgovoi travmy.

Neuroendocrine dysfunction, in particular impaired synthesis of anterior pituitary hormones, is a common complication of traumatic brain injury. Deficiency of tropic pituitary hormones entails a hypofunction of the related peripheral endocrine glands and can be accompanied by persistent endocrine and metabolic disorders. In particular, the hypophyseal mechanisms are the key ones in implementation of most stress effects. Adequate implementation of these mechanisms largely determines a favorable outcome in the acute stage of disease. Traumatic brain injury (as well as any significant injury) initiates a stress response that can not develop in full in the case of pituitary gland failure. It is logical to suppose that the course of the acute phase of stress in the presence of hypopituitarism is different to a certain extent from the typical course, which inevitably affects certain adaptation elements. In this review, we analyzed the adaptive effects of stress after traumatic brain injury.

[Neurosurgery in a patient on dual antiplatelet therapy. Case report and the review of the literature]. / Neirokhirurgicheskoe vmeshatel'stvo u patsienta, nakhodiashchegosia na dvoinoi dezagregantnoi terapii. Opisanie sluchaia i obzor literatury.

INTRODUCTION: A neurosurgical intervention in a patient on dual antiplatelet therapy is a serious challenge for both the neurosurgeon and anesthesiologist.. MATERIAL AND METHODS: The article describes a clinical case of a successful urgent neurosurgical intervention (ventriculoperitoneostomy for obstructive hydrocephalus caused by a large meningioma of the posterior surface of the petrous pyramid) in a patient on dual antiplatelet therapy (DAT) due to a recently placed coronary stent.. CONCLUSION: Given a high risk of coronary stent thrombosis, the surgery was performed in the presence of ongoing DAT. There were no intracranial hemorrhagic complications, but subcutaneous hemorrhagic complications developed. The article discusses the features of managing similar patients whose number is growing.

[The limit of reference range of TSH: long-term discussion and possibilities of modern diagnostic.]

The review considers problem of upper limit of reference interval of TSH that is discussed predominantly by endocrinologists out of laboratory community. The common values of 0.4-4.0 mE/l combine as a matter of fact two ranges: zone of practically full wellbeing (0.4-2.5 mE/l) and zone of latent pathology and/or high possibility of development of clinically significant hypothyroidism (2.5-4.0 mE/l). At one time, the proposal to diminish upper limit of reference interval provoked many discussions and on balance received no approval. However, no unanimity concerning this issue is still to be achieved. The article discusses data forcing medical specialists to be wary of values of TSH in the range of 2.5-4.0 mE/l. At the same time, the question is putted concerning suitability of using population reference intervals in the case of both of TSH and number of other indices of laboratory diagnostic.

[THE PERCENTAGE OF BLOOD SERUM TESTS WITH HEMOLYSIS IN DIFFERENT GROUPS OF PATIENTS].

In the process of laboratory analysis most of the errors occur at the pre-analytical stage. The percentage of blood serum tests with hemolysis is largely applied as an indicator of quality of sampling and transport of blood tests in laboratory. The study was carried out to analyze percentage of tests with hemolysis in different groups of in- and out-patients. The percentage of tests with hemolysis was estimated according actual recommendation of IFCC working group "Laboratory Errors and Patient Safety" as percentage oftests with free hemoglobin more than 0.5 g/l of total amount of serum tests analyzed on biochemical analyzer capable to measure hemolysis index. The hemolysis was identified in 199 (1.4%) out of 14 170 samples. The large dispersion of results in different groups of patient was established. In children younger than 7 years treated in hospital percentage of hemolysis amounted to 2.44%, in patients of reanimation department - 2.38%. In adult patients of hospital this indicator of quality ranged from 0.31% to 1.59%. In two groups of out-patients this indicator amounted to 0.36% (clinic personnel, dispensarization) and 1.81% (out-patients). Such a dispersion complicates inter-laboratory comparison of quality according this particular indicator. The necessity is substantiated to apply more efforts concerning harmonization of indicators of quality in laboratory medicine.

[Prognostic value of D-dimer fibrin level in neurosurgical patients before elective hospitalization].

Deep vein thrombosis and pulmonary embolism in postoperative period are very dangerous complications for patient with any surgical pathology. Frequency of deep vein thrombosis in neurosurgical patient can be up to 25-30%. D-dimer level is considered as one of the most reliable indicator of thrombosis. We measured D-dimer level before hospitalization for elective surgery in 4052 patients with different neurosurgical pathology. It was found clear correlation with elevated D-dimer level and frequency of ultrasound signs of thrombosis. In patients with simultaneous presence of elevated D-dimer level and external signs of varicose veins diagnosis was confirmed by ultrasound in every cases. We consider that D-dimer can be reliable screening method for assessment the risk of thrombosis in neurosurgical patients in preoperative period.

[Protein malnutrition in patient in the early postoperative period after uncomplicated removal of the brain tumors].

Malnutrition leads to adverse effects and may worsen clinical outcome. Surgery as a stress factor activates pathological reactions changing metabolism structure. The aim of this study was to evaluate changes of protein metabolism in patients after elective neurosurgical operation. 24 patients were prepared for elective surgery and were enrolled in this study. Evaluation of each patient included: measurement of anthropometric indices--height, weight, arm circumference and the triceps skinfold thickness, the definition of protein loss by determining the loss of nitrogen in the urine, assessment of protein catabolism, determining the violations of nutritional status upon the base of laboratory parameters. During the course of the conducted investigation significant (p < 0.05) decrease in the indices of total protein, albumin, transferrin and the absolute numbers of lymphocytes in the postoperative period was revealed. All the patients developed severe protein catabolism. It became clear that uncomplicated elective surgical intervention, together with the adopted scheme of the nutritional therapy leads to severe protein catabolism in all patients.

[The hemolysis index as quality indicator for extra-laboratory part of preanalytical phase].

The article considers the new indicator of quality - percentage of samples with hemolysis of free hemoglobin in blood serum lesser than 500 mg/l that corresponds the index of hemolysis lesser than 50 measured using analyzer VITROS 5.1FS (Ortho-clinical diagnostics, USA). The indicator basically is related to quality of implementation of extra-laboratory section of pre-analytical stage of laboratory analysis namely drawing and transportation of blood. This indicator is especially valuable for laboratories charged with organization of samples drawing and transportation at particular territory. The first attempt is made to determine the requirements to quality according this indicator. The optimal level of quality, is the percentage of samples with hemolysis index less than 50 is lower 6.4%. acceptable - 6.4%-8.6%, minimal - 8.7% - 10.9%. The percentage af samples more than 10.9% corresponds to unacceptable level of quality.

[Requirements for analytical quality: use of the concept of biological variation].

By using a clinical biochemistry laboratory as an example, the authors show how the analytical quality system practically operates. The advantages of using a three-level model for analytical quality requirements on the basis of biological variations in analytes are discussed. Only does the use of a few normative documents present a possibility of creating an adequate quality system in a specific laboratory. The long-term coefficient of analytical variation is the most important characteristic of analytical quality and a necessary component of the day-to-day work of the laboratory. The level of quality is shown for 27 analytes. Despite the fact that the laboratory uses the same analytical systems as in the world, the level of analytical quality has turned out to be lower than in the best laboratories of Europe.

[The estimated glomerular filtration rate in outpatients].

The glomerular filtration rate (GFR) calculated by the MDRD formula was estimated in a population of outpatients aged over 18 years. Serum creatinine concentrations were measured, by using 5 analytical systems: Abbott Architect (n = 9054), Roche Modular (n = 22947), Roche Integra 400 (n = 2748), Roche Integra 700 (n = 8350), and Roche Hitachi (n = 20196). For 4 systems, the distribution of GFR differed little. The exception was the Roche Hitachi analytical system where TE and bias were higher than the acceptable requirements. Therefore, with this system, the proportion of outpatients with a GFR of < 60 ml/min per 1.73 m2 was twice higher than that with the use other analytical systems. Such publications should contain data on the analytical quality of measurement of serum creatinine concentrations in the range of 88 to 140 micromol/l. The estimated GFR may be clinically used provided that the performance of this test will be better than the acceptable analytical quality requirements established by the working NKDEP group.

[Testing the acceptability of applied reference intervals, by using serum creatinine as an example].

Unfortunately, the international standard ISO 15189:2003 does not give clear guidelines for the choice, development, and testing the acceptability of reference intervals. The so-called normalization of the frequency distribution of serum creatinine concentrations was carried out in the population of outpatients above 18 years of age. Creatinine concentrations were measured, using 5 analytical systems: Abbott Architect (n=9054), Roche Modular (n = 22,947), Roche Integra 400 (n=2748), Roche Integra 700 (n=8350), and Roche Hitachi (n = 20,196). The obtained 95% confidence intervals were compared with the published reference intervals. It is shown that this approach may be valuable in the assessment of acceptability of the used reference intervals, by taking into account the analytical quality of measurement of creatinine concentrations. Whether there is an association of the analytical quality of measurement of creatinine concentrations and their biological variations with the approaches to developing and using the reference intervals in clinical practice is discussed.

[Blood glucose level as a criterion for surgical stress during ataralgesia and sodium nitroprusside hypotension during the surgical treatment of cerebral arterial aneurysms]. / Uroven' gliukozy v krovi kak kriterii operatsionnogo stressa v usloviiakh ataralgezii i gipotonii nitroprussidom natriia pri khirurgicheskom lechnenii tserebral'nykh arterial'nykh anevrizm.

Test for stress-induced hyperglycemia showed that deep sodium nitroprusside-controlled arterial hypotension in ataralgesia is a powerful stress-producing factor. Additional neurovegetative inhibition by administration of small doses of ganglioblocking agent pentamine is suggested for the prevention hypotension-induced stress.

[Catheterization of the internal jugular vein in the assessment of brain metabolism: right or left side?]. / Kateterizatsiia vnutrennoi iaremnoi veny dlia otsenki tserebral'nogo metabolizma: pravaia ili levaia storona?

Oxygen and glucose were measured in arterial and venous blood of 10 patients operated on for arterial aneurysms of the cerebral vessels. The blood was collected through catheters inserted on the right and left from the internal jugular vein bulb. Blood samples were collected at the beginning and end of surgery simultaneously from 3 sites: artery and right and left veins. The values for the right and left jugular veins initially differed much in 5 out of 11 cases. The causes of these differences are discussed, but this fact makes us doubt the efficacy of catheterization of one internal jugular vein for assessing the cerebral metabolism in various clinical situations.

[Intraoperative reinfusion of erythrocyte mass in neuroanesthesiology]. / Intraoperatsionnaia reinfuziia éritromassy v neiroanesteziologii.

Automated reinfusion of autoerythrocytes prepared from blood lost during removal of tumors was the main component of transfusion therapy in 49 patients (52 operations) with brain tumors. All patients developed massive blood loss of 0.5-5 TCB during the intervention, reinfusion device cell saver C.A.T.S 2-02 (Fresenius, Germany) was used. Various aspects of clinical application of this method are discussed, its efficiency and factors affecting it are analyzed. Special attention is paid to time course of hemostasis values during automated reinfusion and the problem of tumor contamination of reinfused suspension. This latter problem was solved by using the last-generation leukocyte filter RC-400 Klev (Pall, Germany). Automated reinfusion of autoerythromass effectively compensated for massive intraoperative blood loss, on condition of correction of hemostasis disorders by fresh frozen plasma and purification of reinfused suspension from tumor cells by filtering through leukocytic filters. Moreover, our results indicate that utilization of cell saver is obligatory for some patients with supermassive hemorrhages.

[Brain blood flow and cerebral metabolism during ataralgesia]. / Mozgovoi krovotok i tserebral'nyi metabolizm v usloviiakh ataralgezii.

The effect of ataralgesia (diazepam and fentanyl anesthesia) on cerebral blood flow and metabolism has been studied in 9 patients with arterial aneurysms of cerebral vessels. The decrease of cerebral blood flow under anesthesia was observed in 8 out of 9 patients. The brain metabolism reaction varied showing a decrease in 6 patients and an increase in 3 patients.