From transformation to chronification of migraine: pathophysiological and clinical aspects.

Chronic migraine is a neurological disorder characterized by 15 or more headache days per month of which at least 8 days show typical migraine features. The process that describes the development from episodic migraine into chronic migraine is commonly referred to as migraine transformation or chronification. Ample studies have attempted to identify factors associated with migraine transformation from different perspectives. Understanding CM as a pathological brain state with trigeminovascular participation where biological changes occur, we have completed a comprehensive review on the clinical, epidemiological, genetic, molecular, structural, functional, physiological and preclinical evidence available.

[Correlation of clinico-neurological peculiarities and morphological signs of small hernias (protrusion) of the lumbar intervertebral discs in formation of discogenic pain syndromes in patients of different age].

Morphological signs of small hernias (protrusion) of intervertebral discs (IVD), the results of a neurovisualizing methods of investigation and clinico-neurological features of osteochondrosis as well, were summarized. In young and middle age patients morphological chatacteristics of small hernias (protrusion) of IVD, data of neurovisualizing methods of investigation have had correlated with clinico-neurological features of the disease and were the key determinants while performance of the puncture laser microdiscectomy. In a middle age and elderly patients a weak correlation was noted between the IVD protrusion dimensions and intensity of a lumbar and radicular pain syndromes, functional activity (Osvestry index), what have had permitted to apply a pathogenetically substantiated method of a durable epidural pharmacotherapy. The investigation results witness the necessity of differentiated application of the puncture methods of treatment for the pain discogenic syndromes in patients of different age.

[The first experience with the use of catheter denervation of renal arteries in patients with refractory hypertension].

The prevalence of refractory arterial hypertension in Russia is estimated at 15%. We report the first experience with surgical treatment of this pathology. The method is based on the reduction of activity of the sympathetic nervous system by selective breaking of connections between of neurons with the help of interventional intravascular radiowave ablation. Renal endovascular sympathetic denervation allows to more effectively control AP and optimize antihypertensive therapy but does not ensure recovery from AH.

[Nutritional support in the treatment of gastric cancer].

The investigation involved 307 patients operated on for gastric adenocarcinoma. Nutritional support was given enterally (50), parenterally (98) and by standard methods (159). Enteral nutrition should be recommended because it was followed by relatively higher total protein and serum albumin levels.

[Percutaneous laser diskectomy in cervical osteochondrosis]. / Punktsionnaia lazernaia diskéktomiia pri sheinom osteokhondroze.

The paper presents early and late outcomes of treatment in 62 patients undergone paracentetic laser "diskectomy" for discogenic compressed syndromes of the neck. It shows the efficiency of surgery for radicular (92.9%) and myelopathic (92.8%) syndromes. Patients were selected for these interventions on the basis of clinical and neurological examinations, spondylography, MRI, and electric neuromyography. The main stages of an operation were as follows: local anesthesia, right-sided anterolateral access, X-ray guidance of the position of a needle, one-stage removal of herniated disks during multi-levelled injury during an intervention. The operation lasted 18 +/- 2.4 minutes. The mean hospital stay was 12 +/- 1.4 hours. The interventions were performed in 16 of 62 cases in the outpatient setting.

[Current principles and methods of radical therapy for locally extensive esophageal and gastroesophageal cancer]. / Sovremennye printsipy i metody radikal'nogo lecheniia mectorasprostranennogo raka pishchevoda i kardioèzofageal'noi zony.

The results of radical surgical and combined treatment of 124 cases of esophageal and cardioesphageal tumors are presented. Extensive local disease (stage III, T2-4N0-2M0) was diagnosed in 113 patients (91.1%). Esophagoectomy with transmediastinal esophagogastroplasty and cervical esophagostomy proved most useful for esophageal tumor, while extensive surgery after Lewis in combination with extirpation or proximal resection of the stomach--for proximal gastric disease involving the esophagus. Combined surgery with resection of adjacent organs was carried out in 50%. Post-operative mortality rates were reduced to 7.1% due to application of effective surgical, anesthetic and intensive care procedures. The 3-year survival rate was 26.5%. Prognosis improved significantly when radiation was used prior to dissection of lymph nodes.

[The puncture laser dissectomy application for the discogenic lumbosacral radiculitis]. / Primenenie punktsionnoi lazernoi diskektomii po povodu diskogennogo poiasnichno-kresttsovoho radikulita.

The puncture laser discectomy was conducted in 273 patients with discogenic lumbosacral radiculitis while the conservative therapy inefficacy, pain syndrome in a lumbago stage present and lumboischialgia with absent prominent locomotive disorders and if the intervertebral disc hernia has the size up to 0.6 cm.

[The quality of medical care given to patients with esophageal cancer in St. Petersburg and the Leningrad region]. / Sostoianie lechebnoi pomoshchi bol'nym rakom pishchevoda v Sankt-Peterburge i Leningradskoi oblasti.

The data on the morbidity, time of diagnosis and results of treatment of esophageal cancer in St. Petersburg and Leningrad Region (1992-1994) were analyzed. The morbidity rates were higher in women than in men, the predominant age being over 60. Morphological verification data were not available in almost half the cases. Stage I-II tumors were detected in 15.7-26.5%. Specialized treatment was given to 25%, combination one-to nearly 2%. To raise the standards of medical aid, it is suggested that measures be taken to ensure stable operation of the Cancer Register, St. Petersburg, and to offer treatment to esophageal cancer patients at specialized medical facilities.

[Pathogenesis of colorectal cancer after resection of various segments of the large bowel]. / K voprosy o patogeneze kolorektal'nogo raka posle rezektsii razlichnykh otdelov tolstoi kishki.

The data on 120 cases of primary multiple cancer of the large bowel and 91 cases of diffuse polyposis are discussed. The development, duration and morphological features of metachronous and primary cancer arising after resection of the bowel varying in type and extent were studied. The results pointed to a high risk of cancer in such cases. The study also pointed to disturbances in the enterohepatic system and bile acid circulation as a factor of carcinogenesis in the bowel.

[The early diagnosis of combined craniocerebral injuries in elderly persons]. / Ranniaia diagnostika sochetannykh cherepno-mozgovykh povrezhdenii u lits pozhilogo vozrasta.

A study is presented of 212 elderly patients with associated head injuries. This type of trauma in the elderly is characterized by several features complicating its diagnosis. Knowledge of the anatomo-physiological aspects of the elderly and old, assessment of the injury mechanism, determination of the dominating and concomitant trauma, adequate use of adjunctive diagnostic methods are of importance in the choice of treatment tactics and in the improvement of treatment results.

[Prevention of intracranial hemorrhage in the postoperative period in severe cranio-cerebral trauma]. / Profilaktika vnutricherepnykh krovoizliianii v posleoperatsionnom periode pri tiazheloi.

An analysis of 463 patients operated upon for severe cranio-cerebral traumas has shown that one of the main factors improving results of treatment is using the methods of neurosurgical prophylactics of intracranial hemorrhages in the postoperative period. A considerably less incidence of intracranial hemorrhages can be achieved by using the inflow-outflow dialysis system, removing the crushed brain substance, suturing the dura mater to the periosteum at the borders of the bone defect. The ends of the ligature are taken out onto the skin through the holes in the center of the osseous flap.