[Results of the implementation of measures aimed at improving medical care for patients with vascular diseases in the Tomsk region]. / Itogi realizatsii meropriyatii, napravlennykh na sovershenstvovanie meditsinskoi pomoshchi bol'nym s sosudistymi zabolevaniyami na territorii Tomskoi oblasti.

OBJECTIVE: To study the dynamics of population indicators: the total number of deaths from diseases of the circulatory system, coronary heart disease, cerebrovascular diseases and strokes, hospitalization profile for strokes, their structure and mortality in the Tomsk region for several years in comparison with these indicators for the Russian Federation and the Siberian Federal District. MATERIAL AND METHODS: A retrospective study was conducted using acute cerebrovascular accidents monitoring data and data of the Territorial body of state statistics of the Tomsk region in comparison with the literature data. The indicators of all causes of death, from circulatory diseases, coronary heart disease, cerebrovascular diseases and stroke in the territory of the Tomsk region, profile of hospitalization, structure of acute cerebrovascular accidents were analyzed for several years. Particular attention was paid to case fatality rate, one of the key indicators of the effectiveness of the system of care for patients with stroke. RESULTS: Typical for many regions of the Russian Federation predominance of chronic forms in the structure of mortality from circulatory diseases, the absence of significant differences in the structure of strokes, as well as the features of the Tomsk region in the form of high levels of hospitalization profile and hospital case fatality rate, were revealed. The dependence of hospital mortality on logistics is shown, on the basis of which assumptions are made about the possible causes of high fatality rates in the region: excessive centralization of the system of vascular centers and the absence of really working mechanisms for timely reevacuation from them. CONCLUSION: To bring chronic circulatory diseases structure in line with international standards, it is necessary to regulate the rules for formulating and coding diagnoses. In order to reduce hospital fatality rates in the Tomsk region, it is necessary to carry out organizational measures: opening a primary vascular department in the area of responsibility of the regional stroke center, as well as strengthening rehabilitation and palliative services for the timely reevacuation of patients from vascular centers.

[Evaluation of blood rheology by patients with acute ischemic stroke with Mexidol administration]. / Otsenka reologicheskikh pokazatelei krovi u patsientov s ostrym ishemicheskim insul'tom pri primenenii preparata meksidol.

To study rheological properties of blood in patients with acute ischemic stroke treated with mexidol. MATERIAL AND METHODS: Sixty patients with acute stroke, including 32 patients who received mexidol (500 mg/IV/20 days) and 28 people who received magnesium sulfate (2000 mg/IV/20 days) were examined. The control group included 20 people without a cardiovascular pathology. Blood rheology (viscosity of whole blood, plasma viscosity, hematocrit, aggregation and deformability of erythrocytes, fibrinogen level) was evaluated in patients three times: for the first 12 hours, 3-5 days and 18-20 days after hospitalization. RESULTS: Hyperviscosity syndrome was observed in all patients with stroke. A significant decrease in blood viscosity was found in patients treated with mexidol: in the 3-5th day at low shear rates and in the 18-20th day at 3-100 s-1 shear rates. Significant differences in hematocrit (p=0.026) and fibrinogen levels (p=0.017) in patients treated with different drugs were found in the 18-20th day of the disease. Higher erythrocyte deformability index was recorded in patients treated with mexidol in the 3-5th day at shear rates of 90 and 890 s-1, in the 18-20th day at shear rates of 90-360 s-1. CONCLUSION: The study confirms the impact of mexidol on the fluidity of blood during the acute cerebral ischemia and shows its efficacy in reducing blood viscosity, decreasing the level of hematocrit and fibrinogen, increasing the deformability of erythrocytes.

[Moyamoya disease].

Moyamoya syndrome is a rare chronic progressive disease of brain vessels in which certain arteries in the brain are constricted. During the disease a collateral circulation develops around the blocked vessels to compensate for the blockage, and on angiography these collateral vessels have the appearance of a "puff of smoke". Moyamoya syndrome is extremely rare disease, especially outside of Japan We describe a clinical case of a 27-year-old patient from Tomsk with Moyamoya disease. The clinical features are an acute stroke in the right middle cerebral artery with dysarthria and paralysis of VII and XII cranial nerves. The diagnosis of moyamoya is suggested by MRI-angiogram results in accordance to the diagnostic criteria.

Hemorheological and antioxidant effects of Ascovertin in patients with sclerosis of cerebral arteries.

The clinical trials on 31 patients with arteriosclerosis and I-II stage discirculatory encephalopathy to assess an ability of Ascovertin to limit hemorheology abnormalities were carried out. In patients with discirculatory encephalopathy was a distinct increase in blood viscosity which was induced by disturbances of cell rheological factors: increase in aggregation of erythrocytes and decrease in their deformability were observed in comparison with indices in the group of healthy volunteers. No difference in plasma viscosity and fibrinogen was found. The treatment with Ascovertin in patients with discirculatory encephalopathy improved their attention, memory, mental performance, normalized sleep, releaved headache, decreased fatiquebility, led to the decrease in blood viscosity values, the reduction of pathological erythrocyte hyper aggregation and the improvement of erythrocyte deformability. We partly connect this clinical effect and hemorheology activity of Ascovertin with its antioxidant property--there was found impressive lipid peroxidation suppression. No significant changes in hemorheological and lipid peroxidation indices were observed in patients without Ascovertin.

[Clinical efficacy of a novel hemorheological drug ascovertin in patients with vascular encephalopathy]. / Klinicheskaia éffektivnost' novogo gemoreologicheskogo preparata askovertin u bol'nykh s distsirkuliatornoi éntsefalopatiei.

Patients with stages I and II of vascular encephalopathy developing on the background of atherosclerosis were treated with ascovertin during 21 days. Ascovertin is a complex of flavonoid dihydroquercetin and ascorbic acid. The study group included 21 patients aged 45-65 years and a comparison group consisted of 10 age-matched patients un treated with ascovertin. The ascovertin treatment relieved headache, reduced vertigo and fatigability, improved cognitive functions. The reliable diminishing of whole blood viscosity due to improvement of cellular rheology indices (decrease of aggregation and increase of erythrocyte deformability as well as decrease of indices of lipid peroxidation in erythrocyte membrane and blood plasma) was observed in the stydy group but not in the comparison one.