[Effectiveness of intraoperative monitoring of motor evoked potentials for predicting changes in the neurological status of patients with cervical spinal cord tumors in the early postoperative period]. / Éffektivnost' intraoperatsionnogo monitoringa motornykh vyzvannykh potentsialov pri prognozirovanii dinamiki nevrologicheskogo statusa v rannem posleoperatsionnom periode u patsientov s opukholiami sheinogo otdela spinnogo mozga.

AIM: The study aim was to evaluate the effectiveness of intraoperative monitoring of motor evoked potentials (MEPs) for predicting changes in the neurological status of patients with cervical spinal cord tumors in the early postoperative period. MATERIAL AND METHODS: The study included 74 patients with intradural cervical spinal cord tumors who were operated on using motor evoked potential monitoring in the period from 2013 to 2016. There were 29 (39%) males and 46 (61%) females. Group 1 included 26 (35%) patients with intramedullary tumors; group 2 included 48 (65%) patients with intradural extramedullary tumors. The neurological status was assessed by using a six-grade muscle power MRC scale; a modified McCormick scale was used to evaluate the functional status. Transcranial electrical stimulation of the precentral gyri was performed. Recording electrodes were located in the peripheral target muscles of the upper and lower limbs. Total intravenous anesthesia with propofol and fentanyl was used. RESULTS: In Group 1, MEPs decreased in 19 (73%) of 26 patients; MEPs remained unchanged in 7 (27%) patients. Among the patients with decreased MEPs, 14 (74%) patients had postoperative deterioration of the neurological status; 6 (32%) patients had a preoperative severe neurological deficit; 4 (21%) patients had no changes in the neurological status. The sensitivity and specificity of MEPs from the upper limb muscles were higher than those from the lower limb muscles. In Group 2, improvement of the neurological status occurred in all 48 patients. There was no case of a true positive decrease in the MEP amplitude. CONCLUSIONS: 1. Registration of MEPs is a highly sensitive and highly specific method for diagnosing corticospinal tract dysfunction in patients with intramedullary tumors of the cervical spinal cord. The sensitivity and specificity of MEPs recorded from the upper limbs are higher than those from the lower limb muscles. 2. The sensitivity of MEPs in patients with extramedullary intradural tumors was 0%, the diagnostic effectiveness of MEPs amounted to 86% from the upper limb muscles and 93% from the lower limb muscles. 3. When the MEP amplitude in patients with extra- and intramedullary tumors of the cervical spinal cord decreases, a change in the surgion's approach may reduce or completely eliminate surgically-induced damage to the spinal cord.

[Syringosubarachnoid shunting in treatment of syringomyelia: a literature review and a clinical case report]. / Siringosubarakhnoidal'noe shuntirovanie v lechenii siringomielii: obzor literatury i illiustratsiia klinicheskogo sluchaia.

In the article, we describe a clinical case of syringomyelia associated with an Arnold-Chiari type 1 malformation, evaluate the efficacy of syringosubarachnoid shunting, and analyze the literature data of domestic and international researchers involved in investigation and treatment of the pathology. Application of syringosubarachnoid shunting in the described case resulted in a clinical improvement in the form of regression of paresis and hypoesthesia, which demonstrated the efficacy of the shunting technique for correction of the syringomyelia symptoms.

[Impact of sagittal balance parameters on life quality in elderly and senile patients after surgery for degenerative lumbar spine stenosis]. / Vliianie parametrov sagittal'nogo balansa na kachestvo zhizni u patsientov pozhilogo i starcheskogo vozrasta, operirovannykh po povodu degenerativnogo stenoza poiasnichnogo otdela pozvonochnika.

INTRODUCTION: As the life span and proportion of people over 65 years increase, the incidence of degenerative lumbar spine stenosis grows proportionally. Various parameters of the spinopelvic relationships are used to predict surgical treatment outcomes in patients with degenerative spine diseases. There are no unified protocols for evaluation, in terms of the sagittal balance, of surgical treatment outcomes in elderly patients. PURPOSE: To study the impact of sagittal balance parameters on the life quality of elderly and senile patients after surgery for degenerative stenosis of the lumbar spine. MATERIAL AND METHODS: The study included 109 patients. Decompression was performed in the first group of 53 patients. Decompression and stabilization were performed in the second group of 27 patients. In the third group of 29 patients, XLIF indirect decompression, scoliosis correction, reconstruction of disturbed spinopelvic relationships, and stabilization were carried out. We evaluated the following sagittal balance parameters: pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), lumbar lordosis (LL), and PI minus LL (PI-LL). The quality of life indicators were assessed using VAS, ODI, and SF36 scores. RESULTS: In the first group, there were not statistically significant differences for PT≤20° and PT>20°. A statistically significant change in the PI-LL parameter (p=0.0263) was in the first group. A decrease in PI-LL was accompanied by regression of pain (p<10-4). In the second group, comparison of the quality of life indicators revealed no statistically significant differences between PT≤20° and PT>20° as well as PI-LL≤10° and PI-LL>10 in the postoperative period. In the third group, postoperative improvement in PT (p=0.0002) and PI-LL (p=0.0008) parameters was accompanied by a decrease in pain in the legs (p=0.0002) and lumbar spine (p=0.0001). CONCLUSION: Improvement in the quality of life indicators in 48.6% of cases was achieved by decompression only; the sagittal balance parameters had no significant impact on quality of life. In 24.8% of cases, improvement in the quality of life indicators was achieved by decompression and stabilization because the dominant clinical neurological syndrome was instability. Reduced quality of life in 26.6% of patients was caused by disturbed spinopelvic relationships. Application of the XLIF technique in these patients provides statistically significant restoration of the sagittal balance parameters, PT and PI-LL, which improves quality of life.

[A change in the sagittal balance in elderly and senile patients with degenerative stenosis of the lumbar spine].

Degenerative-dystrophic changes in the spine have general nature, which leads to changes in the balance parameters and consequently, other elements of the musculoskeletal systems. This article is devoted to analysis of the literature data, based on which we conclude that changes in the sagittal balance in elderly and senile patients as the restabilization stage still remain unexpected.

[Injuries of the heart]. / Raneniia serdtsa.

Eighty seven patients with heart injury were treated. Eighteen sufferers died. The success of treatment largely depends on organization of giving surgical aid.

[Comparative study of the circulation of semisynthetic cephalosporins in the blood of rabbits]. / Sravnitel'noe izuchenie tsirkuliatsii polusinteticheskikh tsefalosporinov v krovi u krolikov

Circulation of 4 semisynthetic cephalosporins, such as cephaloridin, cephalotin, cephradin and cephacetryl in the blood of rabbits after their intramuscular administration in single doses of 5 or 20 mg/kg was studied. The above antibiotics were satisfactorily absorbed into the blood reaching the maximum level within 15 to 30 minutes. The blood levels of cephalotin were the lowest and the rate of its elimination from the blood was higher than that of the other drugs. A four-fold increase in the doses of cephalosporins was not accompanied by a proportional increase in their levels in the rabbit blood, the time of the antibiotic circulation in the blood being not significantly changed.