[Portable telemedical complex usage perspectives for medical care of elderly and senile patients with cerebrovascular pathology.]

The article discusses perspectives of medical care in elderly and senile patients with cerebrovascular pathology with portable telemedical complex use. Analysis of telemedical cooperation physician-consultant-patient and discussion of medical equipment criteria for telemedical complex selection and organizational together with legal issues of medical data transfer, storage and access were performed. The important clinical features of cerebrovascular pathology in elderly patients were presented, which determined necessity of highly qualified medical specialist involvement in management of such patients. The opportunities of portable medical complex usage were discussed.

[Prevention of cognitive disorders in elderly and senile patients.]

The aim of the study was to evaluate the effect of vitamin D on the cognitive functions and quality of life in elderly and senile patients with cerebrovascular disease. 100 elderly and senile patients with cerebrovascular disease were examined: 60 people - level 25 (OH)D in blood serum <20 ng/ml (deficiency, pronounced deficiency), in 40 people this indicator was ≥30 ng/ml (within the normal range). Cognitive functions were evaluated according to neuropsychological scales (MMSE, MoCA, FAB, «clock drawing test¼, Schulte tables). To study the quality of life, all patients filled out a general questionnaire SF-36. The body's vitamin D supply was judged by the content of 25 (OH)D in the blood serum. Patients with low vitamin D levels (25 (OH)D <20 ng / ml) were divided into two subgroups: 30 people were prescribed cholecalciferol at a dosage of 8 000 IU/day for three months and 30 people who were not treated with cholecalciferol. The study showed that patients with low levels of vitamin D [25 (OH)D <20 ng/ml] had significantly worse indicators when assessing both cognitive functions and quality of life. The work proved that cognitive functions affect the quality of life. In patients with extremely low levels of vitamin D [25 (OH)D <20 ng/ml], after taking cholecalciferol at a dosage of 8000 IU/day for three months, there was a normalization of the level of 25 (OH)D (the average level of which was 34,10±7,42 ng/ml) in the blood serum and there was a significantly significant positive dynamics in assessing cognitive functions and quality of life.

[The efficacy of mexidol in carotid endarterectomy procedure in patients with cerebral atherosclerotic stenosis].

OBJECTIVE: To determine the antihypoxic efficacy of mexidol in carotid endarterectomy (CE) procedure in patients with cerebral atherosclerotic stenosis using cerebral oximetry. MATERIAL AND METHODS: Clinical/psycho/neurological monitoring was performed in 109 patients with internal carotid artery stenosis of 69±7.0% and neurological symptoms of cerebral ischemia, 2-3 degree, in pre- and postoperative periods. Cerebral oximetry was carried out perioperatively. Fifty-four patients were treated with mexidol in a dose of 1000 mg/day for 14-15 days and 55 patients did not received mexidol. RESULTS AND CONCLUSION: The difference in initial brain oxygenation (rSO2) between the main and comparison groups was shown (60.8±5.0 and 47.29±5.5%, respectively). During operation, the degree of blood oxygenation in these groups decreased by 57% and 41%, respectively. On day 7, sinificant differences in the Schulte test in two groups of patients with similar neurological status were found considering efficiency of work and mental stability before and after operation. No differences were found in the comparison group. Mexidol used for antihypoxic brain protection in carotid endarterectomy of patients with cerebral atherosclerotic stenosis significantly reduces the degree of cerebral hypoxia, decreases the duration of surgery, improves neurological status of patients and performance of psychological tests in postoperative period.

[Modern diagnostic methods in multiple sclerosis]. / Sovremennye metody diagnostiki rasseiannogo skleroza.

161 patients with multiple sclerosis were observed according to C. M. Poser's scale. The diagnosis was definite in 73.9% of cases, probable--in 14.9% and doubtful in 11.2% of patients. The diagnostic significance of magnetic resonance tomography (MRT) was estimated as well as of visual evoked potentials (VEPs), mid-latency auditory evoked potentials (MAEPs), viscocontrastoperimetry and pallesthesiometry (vibratory sensation). MRT revealed alterations in 80.3% of 71 cases (97.5% at definite diagnosis). The results of investigation of evoked potentials differed from normal values: VEPs in 100%, MAEPs in 72.6% of 26 patients observed. Visocontrastoperimetry revealed disorders in 75,2% of 113 cases, pallesthesiometry in toes--in 100%, in fingers--in 68.9% of 116 patients observed.

[The interdependence between neurodynamic indices and the state of the hearing in blast trauma]. / O vzaimozavisimosti mezhdu pokazateliami neirodinamiki i sostoianiem slukha pri vzryvnoi travme.

The authors have proved that in the blast trauma diagnosis of the organ of hearing in slight or middle-gravity cases it was necessary to applicate such important additional methods of researching as pure-tone and speech audiometry, and EEG. It gives the possibility to reveal the affections in primary and secondary cortical fields of temporal, occipital and frontal lobes, prognosticate the possible outcome of hearing pathology, elaborate optimal schemes of treatment, control the efficiency of therapy, and also make expert evidence conclusions. It was proved that the diminished hearing in patients who had suffered from blast injuries have a direct correlative dependency upon pathological deviations in EEG indexes. The severe neurodynamic disorders form an unfavourable background for recovery of hearing.

[Role of specific brain peptide factors in the pathogenesis and compensation of neurologic disorders and their use in the treatment of nervous system diseases]. / Rol' spetsificheskikh peptidnykh faktorov mozga v patogeneze i kompensatsii nevrologicheskikh rasstroistv i ikh ispol'zovanie v klinike nervnykh boleznei.

New concepts of the molecular mechanisms implicated in the pathogenesis and compensation of central motor disorders are presented. It has been shown experimentally that specific peptide, postural asymmetry, and inactivation factors, play the leading part in these processes. The detection of these specific factors in the cerebrospinal fluid (CSF) of patients and convalescents allowed one to work out and test clinically a new method of treatment (CSF therapy) of patients with central motor disorders of varying genesis. The results of the clinical observations of two patients' groups (with cerebrovascular brain lesions and multiple sclerosis) are provided.

[The neurological manifestations of blast trauma to the brain]. / Nevrologicheskie proiavleniia vzryvnoi travmy golovnogo mozga.

The article describes mechanisms of cerebral injuries and clinical symptomatology of light and medium trauma. It is stressed that a certain succession in medical and diagnostical measures must be observed, as well as physicians of several medical specialties must participate in the treatment of such cases. There is a description of morphological picture of cerebrum in this type of trauma. The article also shows pathogenetical and clinical differences between burst and mechanical brain injuries.

[Pathogenetic role of prolactinemia in multiple sclerosis]. / Patogeneticheskoe znachenie prolaktinemii pri rasseiannom skleroze.

RIA and rosette formation were employed to measure the content of prolactin and lymphocyte populations in the blood of 26 men and 36 women suffering from multiple sclerosis (MS). Hyperprolactinemia was discovered to be attended by a decline of the T lymphocyte count, whereas hypoprolactinemia was marked by the impairment of the ratio of active to total "rosettes". In addition, 16 MS women suffering from persistent galactorrhea-amenorrhea and 40 parturients and lactating women with MS were examined with a special purpose in view. A relationship was demonstrated between exacerbation and development of MS and the status of ++immuno-endocrine regulation.

[Homeostatic effect of thymalin in multiple sclerosis]. / Gomeostaticheskoe deistvie timalina pri rasseiannom skleroze.

The paper is concerned with interaction of the immune, endocrine and nervous systems in patients with multiple sclerosis. Dexamethasone and vasopressine tests were made. Lymphocyte sensitivity to hydrocortisone and thymalin, the main protein of myelin, was detected. It is advisable that arginine-vasopressine combined with thymalin be used for correction of homeostatic abnormalities and secondary disease prophylaxis.

[Neuroendocrine aspects of the pathogenesis and treatment of disseminated sclerosis and lateral amyotrophic sclerosis]. / Neiroéndokrinnye aspekty patogeneza i lecheniia rasseiannogo skleroza i bokovogo amiotroficheskogo skleroza.

Comparative study of neurologic, immunologic, and endocrinologic signs of disseminated sclerosis and lateral amyotrophic sclerosis was carried out by radioimmunoassay, monoclonal antibodies, and microcytotoxic Terasaki's test. The data have shown a tendency to hyperthyroid and hypocorticoid states in 60 percent of lateral amyotrophic sclerosis patients. Fluctuations in hormonal levels of disseminated sclerosis patients were quite the opposite in 37.5 percent of cases. Thyrotropic hormone content was rarely changed (in 20 and 18.75 percent of cases, respectively), this permitting a conclusion on the possibility of an extrahypophyseal (thymic) effect on the thyroid in these conditions and on the advisability of using thyrotropin- and corticotropin-releasing hormones (8-arginine-vasopressin) in combined therapy thereof.

[Multifactorial pathogenesis and immunoendocrine modulation of multiple sclerosis]. / Mul'tifaktorial'nost' patogeneza i immunoéndokrinnaia moduliatsiia rasseiannogo skleroza.

The results of immunogenetic screening of 300 patients with multiple sclerosis (MS) were subjected to factorial analysis. Nine significant factors indicative of secondary immunodeficiency were elucidated. The development and course of the disease were found to be affected by lipid metabolism disorders and endocrine deviations in the thymus-adrenal system. The authors postulate the principle of permanent immunoendocrine modulation in the treatment of MS. They also present data on hemosorption, lympho- and immunostimulation, as well as on correction of the interferon and cytochrome system.

[Pathogenesis and treatment of migraine (neuroendocrinologic aspect)]. / K patogenezu i lecheniiu migreni (neiroéndokrinologicheskii aspekt).

In 24 women with simple and ophthalamic migraine the authors employed neuropeptide 8-arginine-vasopressin under control of plasma levels of ACTH and cortisol and rheoencephalographic parameters. The authors observed a marked clinical effect, normalization of hypothalamoadrenal function and improvement in the cerebral hemodynamics.