[Diagnosis and new treatment options for pituitary adenomas].

Currently, the treatment of pituitary adenomas is inextricably linked with transsphenoidal neurosurgical intervention. Modern technologies used in surgery for this pituitary pathology, such as endoscopy using angled optics, as well as the use of specialized instruments, sealing and hemostatic materials, increase the effectiveness of surgical treatment of pituitary adenomas and reduce the incidence of intraand postoperative complications. The development of radiation methods of diagnostics, such as MRI, makes it possible to more accurately identify the formation of the pituitary gland, assess its size, direction of growth, and the degree of invasion of surrounding tissues. The authors of the article described in detail the modern technique of transsphenoidal removal of pituitary adenoma using an endoscope. Each stage of the operation is described step by step, taking into account various anatomical features and illustrated. This article discusses the MRI characteristics of pituitary adenomas: size of the tumor, the direction of its growth, the degree of invasion of the cavernous sinuses, the compression effect on the structures of the chiasmal-sellar region. The use of treatment methods, knowledge of the features of MRI diagnostics described in this article greatly increase the effectiveness of the treatment of patients with pituitary adenomas and reduce the risk of complications after neurosurgical intervention in such patients.

The influence of arm positions on abdominal image quality of whole-body computed tomography in trauma: systematic review.

PURPOSE: Whole-body computed tomography (WBCT) is the standard diagnostic method for evaluating polytrauma patients. When patients are unable to elevate their arms, the arms are placed along the body, which affects the image quality negatively. Aim of this systematic review is to evaluate the influence of below the shoulder arm positions on image quality of WBCT. METHODS: Literature in PubMed and Scopus databases was systematically searched. Results of the papers were stratified into 4 categories: arms elevated, 1 arm up 1 arm down, arms ventrally supported, arms along the body. A qualitative analysis was performed on subjective image quality and a quantitative analysis on objective quality (image noise). RESULTS: Eight studies were included with 1421 participants. Various studies reported significantly higher quality scores with arms elevated, compared to arms along the body. Significant differences in objective image quality were found between the arms elevated and the arms ventrally on support group. The arms ventrally supported group had a significantly higher image quality than the arms along the body group. A statistically significant difference was found in objective image quality between the 1 arm up 1 arm down and arms along the body group. No preferential below the shoulders position could be identified. CONCLUSION: Positioning the arms alongside the body results in a poor image quality. Placing the arms on a pillow ventrally to the chest improves image quality. Interestingly, asymmetrical arm positioning has potential to improve the image quality for patients that are unable to elevate the arms.

Intraoperative verification of resection margins of maxillary malignancies by cone-beam computed tomography.

Resection of maxillary cancer often results in incomplete excision because of the tumour's proximity to important structures such as the orbit. To deal with this problem we prospectively investigated the feasibility of intraoperative imaging during maxillectomy to verify the planned resection margins. In total, six patients diagnosed with maxillary cancer listed for maxillectomy were included, irrespective of the histological type of tumour. Before resection, an accurate intended resection volume was delineated on diagnostic images. At the end of the operation we took a cone-beam computed tomographic (CT) scan of the treated maxilla, after which the accuracy of the resection was quantitatively evaluated by comparing the preoperative resection plan and the images acquired intraoperatively, based on the anatomy. Further resection was then done if necessary and quantitatively evaluated with a second cone-beam CT scan. Postoperatively we compared the results of the scan with those of the histological examination. Of the six, two resections were reported pathologically as less than radical, each of which was detected by intraoperative CT and resulted in extensions of the original resections. The mean (SD) distance between the planned and the actual resection was 1.49 (2.78)mm. This suggests that intraoperative cone-beam CT imaging is a promising way to make an adequate intraoperative assessment of planned surgical margins of maxillary tumours. This allows for intraoperative resection margins to be improved, possibly leading to a better prognosis for the patient.

In vivo biodistribution of stable spherical and filamentous micelles probed by high-sensitivity SPECT.

Understanding how nanoparticle properties such as size, morphology and rigidity influence their circulation time and biodistribution is essential for the development of nanomedicine therapies. Herein we assess the influence of morphology on cellular internalization, in vivo biodistribution and circulation time of nanocarriers using polystyrene-b-poly(ethylene oxide) micelles of spherical or elongated morphology. The glassy nature of polystyrene guarantees the morphological stability of the carriers in vivo and by encapsulating Indium-111 in their core, an assessment of the longitudinal in vivo biodistribution of the particles in healthy mice is performed with single photon emission computed tomography imaging. Our results show prolonged blood circulation, longer than 24 hours, for all micelle morphologies studied. Dynamics of micelle accumulation in the liver and other organs of the reticuloendothelial system show a size-dependent nature and late stage liver clearance is observed for the elongated morphology. Apparent contradictions between recent similar studies can be resolved by considering the effects of flexibility and degradation of the elongated micelles on their circulation time and biodistribution.

[MONITORING OF CEREBRAL OXYGENATION AND COGNITIVE FUNCTION IN CAROTID ENDARTERECTOMY: THE ROLE OF TRANSIENT BYPASS OF CAROTID ARTERY].

UNLABELLED: BACKGROUND AND OBJECTVE: Carotid endarterectomy (CEE) is an effective surgical technique to prevent cerebral ischemia and stroke, but can be associated with intervention-related complications. The surgical shunting of the intervention area may reduce the risk of the intraoperative ipsilateral cerebral ischemia following the carotid artery clamping but is controversial. The goal of this study was to compare the cerebral tissue oxygen saturation (SctO2) and early changes of cognitive functions in CEE in the settings of transient vascular bypass and without this method. METHODS: 45 adult patients were randomized to either the bypass group (the Bypass group, n = 24) or the Controls / No Bypass (the Control group, n = 21). All patients were monitored for invasive arterial pressure, SpO, EtCO,, and cerebral oxygenation (SctO2, Fore-Sight, CASMED, USA) over the contra- and ipsilateral frontal head areas. The cognitive functions were assessed using series of Montreal Cognitive Assessment score (MoCA) before the intervention, and on 6 and 36 hrs after the CEE. RESULTS: We did not find intergroup differences in the surgery duration, degree of stenosis and baseline cognitive function. The values of SctO2 reduced significantly only above contralateral side; these changes were attenuated in the shunt group. There were no intergroup differences in postoperative cognitive function. CONCLUSION: Empiric transient vascular bypass during carotid endarterectomy did not result in significant changes of the ipsilateral cerebral oxygenation, hyperperfusion and cognitive function, but attenuated the decrease of SctO2 over the contralateral hemisphere.

[Interhemispheric EEG coherence in men with abnormal sexual behavior]. / Mezhpolusharnaia kogerentnost' EEG u muzhchin s anomal'nym seksual'nym povedeniem.

Interhemispheric interactions were examined in individuals with abnormal sexual behaviour by means of method of evaluation of coherent EEG properties in symmetric points of two hemispheres in different levels of awakening and in elaboration of cognitive tests related with preferential activation of one of two hemispheres. It was determined that EEG of the individuals who had committed sexual deliquency and had the signs of paraphilia was characterized by diffuse elevation of the degree of interhemispheric coherence in alpha-activity in the state of both passive and active awakening and by its local elevation in theta-activity. The results obtained might testify to the disorders either in cortical-subcortical interactions and in the cortical processes and permitted to suppose the decrease of degree of functional hemispheric lateralization in persons with paraphilias.

[Hemispheric lateralization of the visual-spatial function in chronic alcoholic intoxication in humans]. / O polusharnoi lateralizatsii zritel'no-prostranstvennoi funktsii pri khronicheskoi alkogol'noi intoksikatsii u cheloveka.

A series of behavioural and electrophysiological parameters was recorded in subjects with chronic alcohol intoxication during solving of visual-spatial nonverbalized task. It is shown that in comparison with the healthy subjects, their reaction time (RT) of correct decisions was increased; it was more expressed when stimuli were presented in the left visual field, i.e., directly to the right hemisphere, and the number of correct reactions decreased at stimuli presentation directly to the left hemisphere. During repeated tests there were no changes in the number of correct reactions and RT value in the group with chronic alcohol intoxication. It is found that long-term taking of alcohol produces an increase of latency and decrease of the amplitude of the late positive wave P300, more pronounced in the right cerebral hemisphere.

[Learning to differentiate microintervals of time using verbal feedback]. / Obuchenie razlicheniiu mikrointervalov vremeni s pomoshch'iu slovesnoi obratnoi sviazi.

Reaction time (RT) and the number of correct estimations of time microintervals (10 and 180 ms) between two visual stimuli were recorded in healthy subjects. It has been shown that 10 ms interval is better estimated when the stimuli are presented in the right visual field, i.e. when they are addressed directly to the left hemisphere. At the same time the number of correct estimations of 180 ms interval is greater and their RT is less when the stimuli are addressed directly to the right hemisphere. This points to different hemispheric mechanisms of time microintervals estimation. Study of the influence of different forms of verbal reinforcement on this learning has shown that after positive reinforcement (the word "good") the number of correct estimations is on average by 10% greater than after negative reinforcement (the word "error"). This may be connected with such processes as isolation and identification of erroneous reaction.

[Hemispheric lateralization of visuo-spatial function in man]. / O polusharnoi lateralizatsii zritel'no-prostranstvennoi funktsii u cheloveka.

Two parts of a geometrical figure are consecutively presented to healthy adult subjects in the left and right visual fields; the subjects have to compare them mentally and to decide whether these parts form a standard figure or not. Correctness of the reaction is controlled by a computer which lights up on the screen the words "good" or "error". The number of correct decisions of this visual-spatial task does not depend on the hemisphere to which information is addressed. The reaction time is substantially shorter if the information comes "directly" to the right hemisphere. Due to better training in the left hemisphere interhemispheric difference in reaction time gradually disappears in repeated tests. Training to mental "constructing" takes place only in the tests following positive feedback stimulus. Analysis of amplitude-temporal parameters of P300 wave shows that at correct decision of the visual-spatial task the level of activation in the right hemisphere is higher than in the left one.

[Dynamics of cortical evoked activity during human learning to discriminate microintervals of time using feedback]. / Dinamika korkovoi vyzvannoi aktivnosti v protsesse obucheniia cheloveka razlicheniiu mikrointervalov vremeni s pomoshch'iu obratnoi sviazi.

The dynamics of the cortical evoked activity in the process of learning of time microintervals (10, 60 and 180 ms) discrimination was studied in healthy adults. Feedback stimulus visually informing of the real correlations of the differentiated pauses facilitates the discrimination. The factor of the visual field does not affect the estimation of brief time intervals. At correct identifications, the P300 wave is recorded with a higher amplitude, than at errors. In the trial following the "nonconfirming" feedback stimulus, the standard and test stimuli evoke in the left hemisphere a greater P300 wave, than in the trial after the "confirming" stimulus. Feedback influence is retained in the long-term memory.

[Effect of verbal reinforcement on evoked cortical activity]. / Vliianie slovesnogo podkrepleniia na vyzvannuiu korkovuiu aktivnost.

Adult healthy subjects did not manifest any difference in latency and amplitude of the wave P300 elicited by a positive ("good") and negative ("error") reinforcing stimuli. After the negative reinforcement, the P300 wave amplitude decreases in response to the standard stimulus (light bars) and increases to a lesser degree in response to test stimuli (the same bars but presented with different pauses). In the processes of learning to assess time microintervals in comparison with the standard, the latency of wave P300 to the test stimuli shortens. It is suggested that formation and consolidation of feedback connection elaborated with the participation of a reinforcing verbal stimulus constitute the physiological basis for learning of comparative assessment of time microintervals.

[Lateralization of perception of short time intervals and cortical evoked activity in man]. / Lateralizatsiia vospriiatiia korotkikh intervalov vremeni i korkovaia vyzvannaia aktivnost' u cheloveka.

Recognition of short time intervals (10, 60, and 180 ms) between visual stimuli presented to the left or right hemisphere was studied in adult healthy people. The interval of 180 ms is recognized better than that of 10 or 60 ms. Learning with repeated tests with 180 ms intervals proceeds better than that with short intervals. The predominance of the left hemisphere has been revealed only for perception of 10 ms interval. The other time intervals asymmetry is not observed. It is suggested that the left hemisphere is predominant in estimation of short (less than 60 ms) time intervals. In formation of time nervous model a significant role is played by local activation of the cortical zone where the standard stimulus is addressed.

[Effect of music on motor reaction time and interhemispheric relations]. / Vliianie muzyki na vremia dvigatel'noi reaktsii i mezhpolusharnye otnosheniia.

Influence of music on motor reaction time (RT) was studied. Warning and triggering stimuli were presented either in the left or in the right visual fields. RT was recorded when playing classical or variety music; control sessions were not accompanied by music. Music shortened RT, and its stimulating effect was the stronger the longer were the initial RTs without music. The influence of variety music was more effective than of the classic one. RT was shortened more when the triggering stimulus was presented in the left visual field. This phenomenon is considered to be an evidence of predominant influence of music on the right cerebral hemisphere due to greater activation from emotional structures.