[Drainage-associated meningitis in neurocritical care patients. The results of a five-year prospective study]. / Drenazh-assotsiirovannye meningity u patsientov otdeleniia neiroreanimatsii. Rezul'taty piatiletnego prospektivnogo nabliudeniia.

AIM: to determine the incidence rate and risk factors for drainage-associated meningitis in neurocritical care patients. MATERIAL AND METHODS: The prospective study included 539 patients who spent more than 48 h at the Department of Neurocritical Care and underwent external ventricular drainage. The incidence rate and risk factors for drainage-associated meningitis were evaluated. RESULTS: Over a 5-year period, 2140 patients have been hospitalized to the Department of Critical and Intensive Care (DCIC) for more than 48 h; of these, 539 patients underwent external ventricular drainage (EVD). Drainage-associated meningitis developed in 99 patients, which amounted to 19.8 (CI 16.3-23.3) per 100 patients with drainage and 18.3 (CI 14.3-22.2) per 1000 days of drainage. The incidence rate of drainage-associated meningitis did not significantly correlate with different neurosurgical diseases, but there was a tendency for meningitis to predominate in EVD patients with vascular pathology of the central nervous system (CNS). The rate of artery catheterization for direct measurement of systemic BP and the use of vasopressor agents were significantly higher in the group of patients with drainage-associated meningitis (p<0.05). ALV was used in 98 (99%) of 99 patients with drainage-associated meningitis; respiratory support was used in 325 (80.8%) patients without meningitis (p<0.01). An analysis of the ventricular drainage duration revealed a significantly (p<0.05) larger number of days of using EVD in the group of patients with drainage-associated meningitis. In most critical care patients (57.6%), meningitis developed during the first week of drainage. Cerebrospinal fluid leakage occurred significantly more frequently in patients with drainage-associated meningitis than in patients with EVD and without meningitis (p<0.01). Based on a microbiological examination, the etiology of drainage-associated meningitis was established in 57.1% of cases. The leading pathogens were coagulase-negative staphylococci (48.3%) and Acinetobacter baumannii (18.3%). CONCLUSION: The incidence rate of drainage-associated meningitis was 19.8 per 100 patients and 18.3 per 1000 days of drainage. The risk factors significantly predominating in patients with drainage-associated meningitis include the duration of drainage, association with external CSF leakage, as well as factors associated with indicators of the overall severity of the condition.

[The rate of hyponatremia in neurosurgical patients (comparison between the data from the Burdenko Neurosurgical Instutite and the literature) and recommendations for the diagnosis and treatment].

UNLABELLED: Hyponatremia is a relatively frequent and serious complication in patients with various neurosurgical pathologies. OBJECTIVE: This study is aimed at assessing the incidence of hyponatremia in neurosurgical patients depending on the pathology. MATERIAL AND METHODS: This paper presents a retrospective analysis 39 479 cases of patients operated on at the Burdenko Neurosurgical Institute from 2008 to 2014. RESULTS: A total of 785 hyponatremic patients with Na level lower than 130 mmol/l (2% of all operated patients) were identified. Mortality in patients with hyponatremia was 14.3%, which is tenfold higher compared to the rest of population of patients without hyponatremia who were operated on during the same period. In adults, hyponatremia most frequently occurred after resection of craniopharyngiomas (11%) and as a result of acute cerebrovascular accident (22%). In children, it occurred after resection of craniopharyngiomas (10%), astrocytomas (7%), ependymomas (24%), and germ cell tumors (10.5%). CONCLUSION: This study, which was mainly statistical one, was not aimed at detailed investigation of hyponatremia in different groups of neurosurgical patients. We only tried to draw the attention of various experts to those categories of patients, where focused and in-depth developments are more than important. Obviously, already gained international experience should be taken into account for this PURPOSE: Therefore, this article presents the literature data on the etiology and pathogenesis of hyponatremia. We describe the details of the various classifications of hyponatremia, its clinical symptoms, diagnosis, and treatments, primarily based on the recommendations of the last European consensus of various specialists (2014).

[Prognostic value of D-dimer fibrin level in neurosurgical patients before elective hospitalization].

Deep vein thrombosis and pulmonary embolism in postoperative period are very dangerous complications for patient with any surgical pathology. Frequency of deep vein thrombosis in neurosurgical patient can be up to 25-30%. D-dimer level is considered as one of the most reliable indicator of thrombosis. We measured D-dimer level before hospitalization for elective surgery in 4052 patients with different neurosurgical pathology. It was found clear correlation with elevated D-dimer level and frequency of ultrasound signs of thrombosis. In patients with simultaneous presence of elevated D-dimer level and external signs of varicose veins diagnosis was confirmed by ultrasound in every cases. We consider that D-dimer can be reliable screening method for assessment the risk of thrombosis in neurosurgical patients in preoperative period.

[Protein malnutrition in patient in the early postoperative period after uncomplicated removal of the brain tumors].

Malnutrition leads to adverse effects and may worsen clinical outcome. Surgery as a stress factor activates pathological reactions changing metabolism structure. The aim of this study was to evaluate changes of protein metabolism in patients after elective neurosurgical operation. 24 patients were prepared for elective surgery and were enrolled in this study. Evaluation of each patient included: measurement of anthropometric indices--height, weight, arm circumference and the triceps skinfold thickness, the definition of protein loss by determining the loss of nitrogen in the urine, assessment of protein catabolism, determining the violations of nutritional status upon the base of laboratory parameters. During the course of the conducted investigation significant (p < 0.05) decrease in the indices of total protein, albumin, transferrin and the absolute numbers of lymphocytes in the postoperative period was revealed. All the patients developed severe protein catabolism. It became clear that uncomplicated elective surgical intervention, together with the adopted scheme of the nutritional therapy leads to severe protein catabolism in all patients.

[Requirements for analytical quality: use of the concept of biological variation].

By using a clinical biochemistry laboratory as an example, the authors show how the analytical quality system practically operates. The advantages of using a three-level model for analytical quality requirements on the basis of biological variations in analytes are discussed. Only does the use of a few normative documents present a possibility of creating an adequate quality system in a specific laboratory. The long-term coefficient of analytical variation is the most important characteristic of analytical quality and a necessary component of the day-to-day work of the laboratory. The level of quality is shown for 27 analytes. Despite the fact that the laboratory uses the same analytical systems as in the world, the level of analytical quality has turned out to be lower than in the best laboratories of Europe.

[Role of plasmalemma in the process of aging, elimination and reproduction of erythrocytes: plasmalemmal microvesicles as stimulators of erythropoiesis]. / Rol' plazmalemmy v protsessakh stareniia, eliminatsii i vosproizvodstva eritrotsitov: mikrovezikuly plazmalemmy kak stimuliatory eritropoeza.

This study summarizes the experimental findings suggesting that plasmalemmal microvesicles formed from red blood cell aging are stimulators of erythropoiesis. The supposed sequence of events consists of microvesicular absorption by the settled macrophages of the liver and spleen, a message of information from circulatory monocytes (and lymphocytes) to the central macrophage of erythropoietic islands and regulation of late erythropoiesis. This is an autoerythronic regulation because it corrects red blood cell reproduction in relation to the rate of cell aging and thus differs from the classical humoral type which regulates erythrocytic reproduction according to visceral oxygen supply.

[Stimulation of erythropoiesis in hemorrhage during pregnancy using microvesicles from erythrocyte plasmolemma]. / Stimuliatsiia éritropoéza pri krovopotere na fone beremennosti s pomoshch'iu mikrovezikul iz plazmolemmy éritrotsitov.

Autologous microvesicles of erythrocyte plasmalemma were obtained by means of ultrasound treatment of erythrocyte suspension. These microvesicles were intravenously (i.v.) injected to pregnant rabbits with artificial bleeding at the 21st day of gestation. Three i.v. injections of microvesicles with 1-3 day interval at the amount equal to 1% of the weight of the circulating erythrocyte plasmalemma increased almost to the control level the number of erythrocytes and hemoglobulin by the 8th day after the bleeding while these indices were much lower in untreated animals.

[The effect of eicosapentaenoic acid and the calcium antagonist isradipin on lipid metabolism and erythrocytes in experimental hypercholesterolemia in rabbits]. / Deistvie éikozapentaenovoi kisloty i antagonista kal'tsiia isradipina na lipidnyi obmen i éritrotsity pri éksperimental'noi giperkholesterinemii u krolikov.

The effects of eicosapentaenoic acid (EPA) and a new dihydropyridine calcium antagonist isradipine on plasma cholesterol free fatty acids (FFA) and erythrocytes have been studied in 48 cholesterol-fed rabbits after 3-month experiment. EPA had no statistically significant reduction of total cholesterol, FFA but showed the accumulation of cholesterol in plasma and altered morphological and functional properties of erythrocytes. Isradipine revealed a dose-dependent reduction of hypercholesterolemia. levels of FFA in plasma and improved functions of erythrocytes. In this way EPA may be suitable for dietary treatment of atherosclerosis, while isradipine may be used for therapy of patients with an antisclerotic vascular system and hyperlipidemia.

[Changes in the indices of lipid peroxidation in liver mitochondria of white rats during simulation of in vitro anoxic damage]. / Izmeneniia nekotorykh pokazatelei perekisnogo okisleniia lipidov mitokhonrii pecheni belykh krys pri modelirovanii ikh anoksicheskogo povrezhdeniia in vitro.

Lipid peroxidation was studied in the course of the development of anoxic injury to the mitochondria in vitro. Hydrolysis of mitochondial phospholipids was accompanied by an increase in antioxidant activity (AOA) of the organelles. At the same time the ability to transoxidation in liposomes formed from lipids extracted from the injured mitochondria was discovered to be increased. It is assumed that AOA of the mitochondria rises at the expense of antioxidants not extractable with a mixture of chloroform and methanol.