[Platelet hemostasis in patients with ischemic stroke after systemic thrombolytic therapy]. / Osobennosti trombotsitarnogo gemostaza u patsientov s ishemicheskim insul'tom posle provedennoi sistemnoi tromboliticheskoi terapii.

AIM: To study the platelet aggregation (PA) in patients with ischemic stroke (IS) after systemic thrombolytic therapy (TLT). MATERIAL AND METHODS: Twenty-four patients, including 13 with atherothrombotic IS and 11 with cardioembolic IS, have been examined after systemic TLT. Spontaneous and adrenaline-induced PA, international normalized ratio, activated partial thromboplastin time, fibrinogen, neurological deficit severity on the NIHSS (2nd, 6-7th, 12-14th and 21st days after TLT), computed tomography (CT) of the brain (at baseline and 2nd day after TLT) were assessed. RESULTS: The correlation between TLT outcomes and characteristics of spontaneous and adrenaline-induced PA was shown. Patients with initially elevated PA (group 1, n=7) had the lowest NIHSS score in the 21st day. A group of patients with initially reduced PA (group 2, n=17) included a subgroup with no spontaneous aggregation (n=9) and a subgroup with hemostasis system dysregulation manifested with increased spontaneous PA and fibrinogen (n=8), in which the recovery of neurological functions was lower compared to group 1. CONCLUSION: The results of the study can be used for individualization of preventive antiaggregative and anticoagulative therapy after TLT.

[Neuroprotective treatment of chronic cerebrovascular insufficiency].

OBJECTIVE: To study the efficacy of cerebrolysin in 300 patients with chronic brain ischemia (CBI), I and II stages. MATERIAL AND METHODS: The main group consisted of 195 patients with CBI, I stage and 105 patients with CBI, II stage. Patients of the control group (45 patients) did not receive cerebrolysin. Changes in neurological and emotional status, cognitive functions, indicators of platelet and erythrocyte aggregation, their deformity and morpho-densitometric parameters were studied. RESULTS AND CONCLUSION: Authors found the additional mechanisms of cerebrolysin action resulted in the improvement of morpho-densitometric characteristics of erythrocytes and hemorheological properties important for capillary blood flow.

[An impact of neuroprotective therapy on blood rheological and morphodensitometric parameters in patients with chronic cerebral ischemia].

OBJECTIVE: To explore the dynamics of aggregation of platelets and erythrocytes, their deformity and computed morphodensitometric parameters in patients with chronic cerebral ischemia, stages I and II, treated with cerebrolysin. MATERIAL AND METHODS: We examined 300 patients, including 87 men and 213 women, aged from 30 to 55 years. Patients were randomized by disease stage and treatment (standard treatment with or without cerebrolysin). The dynamics of neurological and emotional status as well as cognitive functions and results of laboratory studies were assessed. RESULTS AND CONCLUSION: Along with the total positive effect of cerebrolysin on the clinical picture, additional mechanisms of its action (antiaggregant, antihypoxic and membranotropic) improved the erythrocyte morphodensitometric parameters, hemostatic, hemorheological and blood gas transport characteristics, in particular on the microcirculatory level.

[Ischemic stroke with sinus rhythm in patients with arterial hypertension].

We studied 71 patients with hypertensive disease and sinus rhythm on the ECG without clinical signs of heart failure in the acute stage of ischemic stroke compared to 36 patients with arterial hypertension without complications. A retrospective analysis including 91 patients with uncomplicated arterial hypertension examined previously (3-8 years ago) using the same protocol was carried out. The results of this examination were extracted from our database. The greater hypertrophy of the left ventricular, signs of diastolic dysfunction of the both ventricles and a statistically significant decrease in the blood flow through the right auricle were identified in the patients with the acute cerebral blood flow disturbances. The retrospective analysis of patients with arterial hypertension demonstrated the predictive value of the decrease in the peak velocity of transmitral diastolic flow in the phase of rapid filling Ve in the development of cerebral vascular complications of the disease and lethal outcome.

[Neuroprotective treatment with citicoline (ceraxon) in patients with ischemic stroke].

The dynamics of neurological symptoms assessed with the Scandinavian stroke scale, the Barthel index and the modified Rankin scale was studied in 89 patients with moderate ischemic stroke who received citicoline (ceraxone) intravenously and orally. The results were compared to a group of 52 age-, sex- and stroke-matched patients who did not receive citicoline. To the date of discharge from the hospital (days 21-24), the full restoration (p<0.05) was noted in patients of the main group. Efficacy of citicoline was significantly (p<0.05) higher in patients younger than 70 years and when the drug was used in the first hours of disease.

[Cerebral hemodynamics and cerebral perfusion reserve in patients with diabetes mellitus type 1].

Intracranial cerebral blood flow and cerebral perfusion reserve were examined in 50 patients with diabetes mellitus type I. The results were compared to the control group. There were changes in the intracranial cerebral blood flow and the decrease in cerebral perfusion reserve in patients with diabetes mellitus type I. The degree of the changes was correlated with the disease duration, compensation of carbohydrate metabolism, presence and degree of retino-and nephropathy.

[Prognostic value of hemorheologic and morphodensitometric parameters of blood cells for the progression of cerebrovascular insufficiency].

Authors have studied 484 patients, aged from 35 to 55 years (mean - 41.0+/-1.4 years), in the early stages of cerebrovascular insufficiency. Computed morphodensitometry of erythrocytes, the study of their deformation and aggregation capacity have been used. It have studied the subpopulation content of erythrocytes and determined their morphometric parameters. The morphodensitometric changes in erythrocytes were correlated with disturbances of their functions (aggregation properties, deformation, gas transfer ability) that had the most impact on the hemodynamics of the microcirculation stream. Clinical and laboratory studies revealed that the morphofunctional changes in erythrocytes appeared earlier and played a key pathogenetic role in the formation and progression of cerebral ischemic hypoxia.

[The circadian changes of plasma and blood viscosity and hematocrit in patients with ischemic stroke].

We studied the blood and plasma viscosity and hematocrit in patients with ischemic stroke and in a control group. Patients with ischemic stroke had a marked hyperviscosity and elevated hematocrit levels which were correlated with arterial hypertension, alcohol consumption and tobacco smoking. In women aged 45-55 years, viscosity and hematocrit were correlated with age that may be explained by the hormonal changes. People with ischemic stroke had three variants of circadian patterns of viscosity and hematocrit with peaks at 9 am, 3 pm and 9 pm. In some patents a strong correlation between the time of stroke onset and circadian pattern was observed.

[The beta-fibrinogen gene polymorphism, fibrinogen level and platelet aggregation in patients with ischemic stroke].

We examined an association of the C-148T beta-fibrinogen gene polymorphism with fibrinogen level and platelet aggregation in patients with ischemic stroke and in people with vascular risk factors but no ischemic stroke. Among stroke patients, carriers of an -148T allele had significantly higher plasma fibrinogen level and platelet aggregation to norepinephrin compared to the C/C homozygotes. No significant differences in frequencies of a C-148 allele between stroke patients and controls were observed.

[Pathophysiological mechanisms of hemorrhagic stroke and the ways of differential therapy].

The changes developing in the perifocal area of hematoma and perspectives of antioxidant and chelate therapy were studied on the model of experimental hemorrhagic stroke and in clinical conditions. Microcirculatory, ischemic and inflammation disturbances with a certain time sequence were found in the perifocal areas. These changes, along with hypostasis and oxidative stress, form the pathobiochemical cascade of changes in hemorrhagic stroke and are potential therapeutic targets. Administering of an antioxidant and chelate drug histochrome reduces the intensity of changes in the perifocal area in the experimental conditions. In clinical conditions, it accelerates the dynamics of brain and meningeal symptoms regression and improves the blood rheological properties.

[A compensated form of chronic cerebral ischemia in elderly patients].

The study and treatment of 65-78 year old patients during 10 years allowed the investigators to identify a compensated (stabilized) form of the disease. By the results of clinical and laboratory examination patients of this group occupied the interim position between patients of middle age (45-55 years old) with a stabilized course of chronic cerebral ischemia, stage I, and patients of the same age with the progressive form of stage II of the disease. Some medical and social anti-risk factors for progression and development of chronic cerebral ischemia complications were singled out. The range from the age of 30-32 to 50-55 years old is crucial in future development of cerebrovascular process.

[The neurotropic effect of aplegin (carnitine) in cerebral hypoxia]. / Neirotroficheskoe vliianie aplegina (karnitina) pri gipoksii golovnogo mozga.

Intravenously injected aplegin (carnitine) competitively displacing glucose, includes metabolic shunt of fatty acids, the activity for which was determined by the presence of free carnitine and was not limited by oxygen unlike the aerobic glycolysis. This effect may have paramount importance in acute hypoxia of the brain, and in some other critical conditions. Carnitine has a potent neurotrophic activity. Thus, it inhibits development of apoptosis, limits the area of damage and restores structure of nervous tissue.

[Erythrocyte carboanhydrase and gas metabolism in patients with ischemic stroke]. / Karboangidraza éritrotsitov i metabolizm gazov u bol'nykh ishemicheskim insul'tom.

Gaseous metabolism and carboanhydrase activity of erythrocytes of the capillary and venous blood were studied in 115 persons, including 19 apparently normal subjects, 66 patients with ischemic stroke, and 30 with discirculatory encephalopathy. Patients with cerebral stroke presented gross disorders in the function of carboanhydrase and gaseous metabolism from the first day of the disease which was expressed in an increased oxygenation of the venous blood and hypocapnia, whose severity was correlated with the gravity of the disease course. The authors have established an important pathogenetic role in gaseous metabolism impairment of erythrocyte carboanhydrase, whose activity in the capillary bed in hypocapnia was drastically inhibited, compromising, therefore, the entry of carbon dioxide into erythrocytes, which deteriorated oxyhemoglobin dissociation. The authors consider the possibility of normalizing gaseous metabolism in stroke patients via eliminating CO2 deficit in tissues.

[An improved method of determining the carbonic anhydrase activity of erythrocytes]. / Usovershenstvovannyi metod opredeleniia aktivnosti karboangidrazy éritrotsitov.

The article describes a method of determining erythrocytic carbonic anhydrase activity based on measuring medium pH which characterizes the rate of the carbon dioxide hydration in the borate buffer under the effect of enzyme. The use of modern measuring technique makes it possible to rapidly obtain the results of high precision. The normal activity of the erythrocytic carbonic anhydrase of the capillary blood considerably exceeds that of the enzyme in the vascular bed.

[The role of carotenoids in the development of compensatory reactions of the body to hypoxia]. / Znachenie karotinoidov v formirovanii kompensatornykh reaktsii organizma pri gipoksii.

As a result of the examination of 76 patients with atherosclerosis (57 with ischemic stroke and 19 with chronic cerebrovascular insufficiency) the authors have established a definite correlation between the blood levels of carotinoids and the degree of hypoxia and cerebral ischemia, as well as between pigment concentrations and the oxygen consumption by tissues which indicates an active participation of carotinoids in the processes of body adaptation to hypoxia. The necessity of the drug correction of carotinoid concentrations in patients with ischemic vascular lesions of the brain is justified.

[Erythrocyte elasticity and gas metabolism in ischemic stroke patients]. / Elastichnost' éritrotsitov i metabolizm gazov u bol'nykh s ishemicheskim insul'tom.

In a study involving 126 subjects (61 patients with ischemic cerebral stroke, 25 clinically normal persons and 15 newborns) the authors have established differences in filtrability of erythrocytes of the capillary and venous blood, the range of physiological fluctuations of the elasticity of erythrocytes in capillary blood depending on alimentary factors, the absence of correlations between gas metabolism and erythrocyte filtrability under normal conditions and in minor stroke and the appearance of these correlations in grave patients. Neurovasoactive substances have been found to affect the degree of erythrocytic elasticity.