[Oxidative stress and post-stroke depression]. / Okislitel'nyi stress i postinsul'tnaya depressiya.

OBJECTIVE: To study the use of combination therapy for post-stroke depression using antidepressants and antioxidants. MATERIAL AND METHODS: The dynamics of the clinical status of post-stroke depression and parameters of oxidative stress were evaluated in 60 patients with post-stroke depression before and after a 3-month treatment with fluvoxamine in a daily dose of 100 mg per day and cytoflavin in a dose of 10 ml/day (200 ml of 5% glucose solution or physiological saline in patients with diabetes mellitus) intravenously in the morning for 10 days followed by transfer to tablet form (2 tabs in the morning and 2 tabs in the evening for 90 days). RESULTS AND CONCLUSION: The results on the comparative effectiveness of the treatment of post-stroke depression with fluvoxamine monotherapy and the combination of fluvoxamine and cytoflavin confirmed the great effectiveness of the combination therapy, which should be taken into account when developing new treatment regimens for post-stroke depression, and the need for prescribing antidepressants and antioxidant drugs should be determined based on an individual assessment of the severity of depressive disorder and parameters of oxidative stress: endogenous antioxidant activities in each individual patient with ischemic stroke.

[Perspectives of treatment of patients with ischemic stroke: the place and the role of cytoflavin].

Based on complex clinical-biochemical studies of 60 patients after ischemic stroke (on average 2,4+/-0,3 years from the disease-onset), we showed the disturbance of balance between anti- and prooxidant systems. The changes in the parameters of oxidative stress were revealed as follows: the reduction in the activity of antioxidant defense markers (superoxiddismutase, catalase, oxidized and reduced glutathione), as well as in the spontaneous and induced hemoluminescence, the increase of malonic dialdehyde, a final product of lipid peroxidation. The changes in biochemical parameters were correlated with the severity of ischemic stroke consequences, assessed by the Rankin scale and the Barthel index. This finding points out the necessity of including antioxidants in the rehabilitation treatment. The effect of antioxidant drugs on the consequences of ischemic stroke was studied using cytoflavin (10 ml in 200 ml of 5% glucose solution daily intravenous in drops during 10 days) and cortexin (10 mg in 2 ml of 5% novocaine solution daily intramuscular during 10 days). The results revealed a higher effect of cytoflavin that was supported by the data of clinical-biochemical blood analysis: the level of components of glutathione system and catalase was significantly (p<0,05) increased in patients with sensory-motor disturbances and cognitive disorders thought did not reach the levels of control group.

[The results of brain MRI in patients with vascular and posttraumatic encephalopathy: a comparative study].

Using clinical, psychological methods and MRI, 199 patients with vascular (VE) and posttraumatic encephalopathy (PE) have been studied. It is shown that atherosclerosis, essential hypertension and their combination become relevant at the age of 40 years. Multiple microfocal white matter lesions, leukoaraiosis, extensive bilateral atrophic changes and dilatation of subarachnoid spaces were characteristic of patients with VE (mean age 67+/-10 years). In patients with PE, mean age 22+/-7 years, the local dilatation of subarachnoid space, unilateral dilatation of lateral ventricle and cystic changes in subarachnoid spaces were detected.

[Postural imbalance in patients with vascular brain pathology]. / Postural'nye narusheniia u patsientov s sosudistoi patologiei golovnogo mozga.

Using MRI survey, 163 patients with various brain pathology of vascular genesis were studied. Vascular dementia according to NINDS-AIREN classification was diagnosed in 15% of patients. Cognitive disturbances in other patients did not reach a level of dementia. A control group comprised 61 subjects without rough structural changes on MRI and cognitive dysfunction. Motor disorders were estimated according to classification of J. Nutt et al. (1993), quantitative static changes were registered using computer stabilography. The results of the study showed that postural instability occurs in 100% of patients with vascular brain pathology. A degree of its expression elevated in direct proportion to the expression of cognitive disturbances, reaching a maximum in patients with dementia.

[Use of RR-cardiointervalometry for outcome prognosis in patients in acute period of hemorrhagic stroke]. / Ispol'zovanie metoda RR-kardiointervalometrii dlia prognozirovaniia iskhodov u bol'nykh v ostrom periode gemorragicheskogo insul'ta.

A use of computed express analysis of variations in RR-cardiointerval durations for patients in acute period of hemorrhagic stroke permitted to evaluate the condition severity and disease outcome prognosis before the objective changes of clinical symptomatology. A recovery was reliably observed with a positive and stable trend to U-potential and S-ULF, So, Ik indices normalization. A decrease of the indices towards a critical level was detected in cases with lethal outcome.

[The use of RR-cardiointervalometry for prognosis of disease course and outcome in patients with acute stage of ischemic stroke]. / Ispol'zovanie metoda RR-kardiointervalometrii dlia prognozirovaniia techeniia i iskhoda zabolevaniia u patsientov v ostrom periode ishemicheskogo insul'ta.

The use of computed express analysis of RR-cardiointerval duration variability in patients with acute stage of ischemic stroke allowed to obtain the data on state dynamics and predict the disease outcome before the objective changes in clinical symptomatology. The recovery is observed in normalization of sigma, beta 1, beta 2, U, S-ULF, S-LF and S-HF indices. An opposite trend is observed in cases of lethal outcome.

[Dynamics of the focal neurological disorders in stroke survivors]. / Dinamika ochagovykh nevrologicheskikh narushenii u bl'nykh, perenesshikh insul't.

A study of the neurological disorders was performed in the population of 34-80 year-old stroke survivors. The duration of the period after the stroke was in the range from some weeks till 17 years. The patients were included into the computer post-stroke patients data bank set up in the V.M. Bekhterev Institute. The follow up study has found that aphasic and motor disorders regress more frequently. Tonic disorders of extrapyramidal character aggravate, probably, due to progression of the main vascular process. In patients with location of focus in different hemispheres a decrease of the pyramidal spasticity was observed in the approximately equal degree, while its increase was more often found in patients with right focal process as compared with the left one (22.3% and 9.2%, respectively). Manifestation of the amyostatic disorders was stable (72.7%) in patients with damage of the left hemisphere, as compared with the damage of the right one (50%). Efficiency of restoration of the movements was approximately equal in patients with cortical, subcortical and combined foci in the right or in the left hemisphere of the brain.

[Dynamics of functional state of the post-stroke patients]. / Dinamika funktsional'nogo sostoianiia bol'nykh, perenesshikh insul't.

A dynamics of the functional state was analyzed in 197 patients aged 34-80 years after the stroke that had happened from several weeks to 17 years ago. The patients were included into the stroke patients computer data bank established in Bekhterev's Institute. It was proved possible to use the "PULSES" profile and "Rehabilitation Level" test for objective assessment of both clinical-social outcomes and efficiency of the treatment of patients with consequences of cerebral stroke. There was no any direct correlation between the dynamics of neurological syndrome, on the one hand, and functional state of the patient, his social-working adaptation, on the other hand. It is suggested that both psychophysiologic and social adaptation raise functional potential of patients with consequences of cerebral stroke.

[The clinical evaluation of vasopressin in the treatment of aphasias]. / Klinicheskaia otsenka primeneniia vazopressina v lechenii afazii.

At residual stage of stroke 64 patients with different forms of aphasia were administered intranasally subendocrine doses of 1-desamino-8-D-argininvasopressin (adiuretin-SD). It was established that peptide activates expressive and impressive speech of patients. Improvement of speech occurred in 79% of cases.

[Data bank on post-stroke patients: experience in organization and use]. / Bank dannykh postinsul'tnykh bol'nykh: opyt sozdaniia i ispol'zovaniia.

The bank of clinical data concerning restorative therapy of neurological patients was characterized. These data were included in computer program "System of management of data bank on poststroke patients" which was elaborated in the department of V.M.Bekhterev's St-Petersburg Psychoneurological Institute. Information obtained in process of answering special questionnaire formed this data bank which included social-, demographic, anamnestic, clinical-anatomical data, information about both initial functional state of the patient and its dynamics as well as therapeutic methods applied and follow-up data about the patients which entered the hospital repeatedly, 450 case reports were accumulated in the bank. Practice proved informative value of the bank's materials and its suitability for statistic analysis. Data bank may be used for scientific and statistic purposes as well for control and prognosis of efficiency of treatment of the patients with consequences of cerebral strokes.

[The results of rehabilitative treatment in diseases of the brain of a poststroke and posttraumatic nature and in diseases of the peripheral nervous system]. / Rezul'taty vosstanovitel'nogo lecheniia pri zabolevaniiakh golovnogo mozga postinsul'tnogo i posttravmaticheskogo kharaktera i perifericheskoi nervnoi sistemy.

The authors summarize 20-year experience in the aftercare of 16,088 patients with aftereffects of brain apoplexy or trauma, diseases of the peripheral nervous system. The treatment was performed in special inpatient and outpatient aftercare centres in the city of St. Petersburg. The above treatment was designed as step-by-step complex programs adjusted for individual personality, occupation, etiological and neurological characteristics, etc. Multiple modalities were employed, involving psychological, social, occupational and biological approaches. As shown by 3-5-year follow-up, the programs brought considerable clinical and social benefit.

[A data bank of poststroke patients: the factors affecting the efficacy of the rehabilitative process]. / Bank dannykh postinsul'tnykh bol'nykh: faktory, vliiaiushchie na éffektivnost' reabilitatsionnogo protsessa.

The authors provide the conclusions on the role of some clinical and psychological factors in recovery of postapoplectic patients. Most important of them are: early start of the treatment, the severity of the initial motor dysfunction, combination of some motor and higher cortical defects, multiple and bilateral focal lesions of the brain matter after repeat circulation affections, psychopathological disorders. The conclusions were made after the computer statistical processing of "rehabilitation sheets" compiled by the specialists of the neurological hospital department on the basis of formalized case records of 400 postapoplectic subjects. Each sheet in the data bank contained 1,000 clinical, laboratory and experimental-psychological characteristics.

Therapy of depressions in post-stroke patients.

In a study of 90 patients with post-stroke depression the Hamilton Depression Scale was used together with a clinical psychopathological study. One group of patients was treated with amitriptyline, another with minor tranquilizers (seduxen), and the third (controls) received neither antidepressants, nor tranquilizers. Only treatment in the first group was effective, i.e. depressions were reduced after therapy with amitriptyline So amitriptyline was demonstrated to be the most effective drug of choice in the treatment of non-psychotic post-stroke depressions.

Development and organization of services for alcoholics in Leningrad, USSR.

This report provides a brief, general overview of how alcoholism is reported to be dealt with in one of the Soviet Union's largest cities. It attempts to describe both the philosophical and applied approaches practiced, and affords an opportunity to compare these approaches with those in the United States. Specifically, the paper presents a brief historical review and description of services provided to clients at alcohol treatment centers in the city of Leningrad, USSR, and discusses contemporary Soviet attitudes toward alcoholism.

[System for rehabilitating patients with vascular pathology of the brain]. / Sistema reabilitatsii bol'nykh s sosudistoi patologiei mozga.

The authors have developed a rehabilitation system intended for patients with different cerebrovascular diseases. The system covers initial manifestations of insufficiency of the cerebral blood supply, transient disorders of the cerebral blood circulation, as well as acute, restorative and residual periods of the stroke. The system is being realized in territorial polyclinics, neurologic departments of city hospitals, rehabilitative inpatient centres and polyclinics. Regular medical check-ups constitute the initial and conclusive stage of the system. The system makes it possible to resolve the questions concerning the prophylaxis of stroke, as well as of its complications and recurrences. Methodologically the organization of the therapeutic process is based on principles of rehabilitation which bring together medical, social, and psychological measures. Clinical, social, and occupational outcome suggest a high efficacy of the system and advisability of its wide introduction into clinical practice.