[The balance of markers of regulation vascular tone and fibrinogen in the prognosis of hemorrhagic transformation and fatal outcome in the acute period of ischemic stroke].

The markers of regulation vascular tone, such as rennin, endothelin-1, and C-type natriuretic peptide, are of great value for prognosis of hemorrhagic transformation and fatal outcome of ischemic stroke. A change in the vascular tone in case of hemorrhagic transformation at the affected site precedes activation of the coagulation component of hemostasis as a mechanism preventing blood loss and increasing fibrinogen level. This work was aimed to study the balance of the above markers and fibrinogen in the prognosis of hemorrhagic transformation and fatal outcome in the acute period of ischemic stroke. It included 62 patients receiving no thrombolytic therapy. It was shown that symptomatic hemorrhagic transformation was associated with elevated rennin levels without a marked fall in the level of C-type natriuretic peptide and asymptomatic hemorrhagic transformation with elevated endothelin-1 levels and decreased concentration of natriuretic peptide. Fibrinogen level on day 4 of the observation proved to be a reliable predictor of negative prognosis. Asymptomatic hemorrhagic transformation without fatal outcome was associated with systemic and local vasoconstriction and inhibition of local vasodilation. Symptomatic hemorrhagic transformation with the fatal outcome was accompanied by dysregulation of vascular tone in the form of activation of systemic and local vasoconstriction, insufficient inhibition of local vasodilation and compensatory reaction in the form of activation of hemostatic mechanisms manifest as elevated fibrinogen levels on day 4. The lethal outcome without hemorrhagic transformation was associated with systemic vasoconstriction, activation of local vasodilation and vasoconstriction leading to local "biochemical paralysis" of vascular tone regulation.

[Efficacy and safety of glycine and limontar in the complex therapy of discirculatory encephalopathy and encephalopathy in diabetes mellitus type I].

One hundred and twelve patients with diabetes mellitus type I (DMTI) with different severity and compensation state of the disease were examined. A comparison group included 40 patients with discirculatory encephalopathy (DE). Patients with DMTI and DE were randomized to basic therapy (treatment of glycemia, vasoactive drugs) and treatment with glycine (0,1g) and limontar (0,25 g) 3 times a day. All patients underwent the complex examination including the assessment of neurological and neuropsychological status, the endocrinology clinical-laboratory study, ultrasonic dopplerography of head and neck vessels and transcranial dopplerography with vascular reactivity tests (response to nitroglycerin); direct ophtalmoscopy, the study of plate-let homeostasis. Efficacy and safety of treatment were assessed after 3 months. The dynamics of neurological and neuropsychological status, vascular reactivity results (the increase of number of patients with the adequate response to nitroglycerin), platelet aggregation (the reduction of aggregate size and aggregation velocity), microcirculation disorders (the increase of number of patients with non-proliferative retinopathy and the decrease of those with preproliferative one) were significantly better in the group treated with glycine and limontar. The treatment effect was higher in DMTI patients with encephalopathy that was likely explained by the greater role of microcirculation mechanisms in the formation of encephalopathy in patients with diabetes mellitus.

[Characteristics and peculiarities of the course of encephalopathy in diabetes mellitus].

A complex neurological and neuropsychological study of clinical signs of encephalopathy in patients with diabetes mellitus type I (DM I) was carried out. One hundred and twelve patients with different severity and compensation state of DM were examined. A comparison group included 40 patients with discirculatory encephalopathy. Clinical symptoms of encephalopathy were significantly more frequent in patients with DM I, with the presence of frequent hypoglycemias (more than once a week during the last year). The higher level of glycolized hemoglobin (by more than 6.9%) and longer duration of the disease (more than 5 years) were found in the group of patients with encephalopathy. Ultrasonic dopplerography of head and neck vessels and transcranial dopplerography support the involvement of complex vascular factors in the development of encephalopathy in DM I. The special attention is drawn to the changes in microcirculation channel that contribute to the development of encephalopathy in DM I and determine the characteristics of its clinical presentations and course compared to discirculatory encephalopathy.