[Surgical treatment of eloquent brain area tumors using neurophysiological mapping of the speech and motor areas and conduction tracts]. / Khirurgicheskoe lechenie opukholei funktsional'no znachimykh zon golovnogo mozga s primeneniem metoda neirofiziologicheskogo kartirovaniya rechevykh, motornykh zon i provodyashchikh putei.

AIM: To evaluate the efficacy of intraoperative neurophysiological mapping in removing eloquent brain area tumors (EBATs). MATERIAL AND METHODS: Sixty five EBAT patients underwent surgical treatment using intraoperative neurophysiological mapping at the Pirogov National Medical and Surgical Center in the period from 2014 to 2015. On primary neurological examination, 46 (71%) patients were detected with motor deficits of varying severity. Speech disorders were diagnosed in 17 (26%) patients. Sixteen patients with concomitant or isolated lesions of the speech centers underwent awake surgery using the asleep-awake-asleep protocol. Standard neurophysiological monitoring included transcranial stimulation as well as motor and, if necessary, speech mapping. The motor and speech areas were mapped with allowance for the preoperative planning data (obtained with a navigation station) synchronized with functional MRI. In this case, a broader representation of the motor and speech centers was revealed in 12 (19%) patients. During speech mapping, no speech disorders were detected in 7 patients; in 9 patients, stimulation of the cerebral cortex in the intended surgical area induced motor (3 patients), sensory (4), and amnesic (2) aphasia. In the total group, we identified 11 patients in whom the tumor was located near the internal capsule. Upon mapping of the conduction tracts in the internal capsule area, the stimulus strength during tumor resection was gradually decreased from 10 mA to 5 mA. Tumor resection was stopped when responses retained at a stimulus strength of 5 mA, which, when compared to the navigation data, corresponded to a distance of about 5 mm to the internal capsule. Completeness of tumor resection was evaluated (contrast-enhanced MRI) in all patients on the first postoperative day. RESULTS: According to the control MRI data, the tumor was resected totally in 60% of patients, subtotally in 24% of patients, and partially in 16% of patients. In the early postoperative period, the development or aggravation of a motor neurological deficit was detected in 18 patients: worsening of paresis was observed in 11 patients, and worsening of speech disorders occurred in 7 patients. After 4 months, motor and speech disorders regressed in 10 patients. Therefore, a persistent neurological deficit developed after surgery in 8 (12%) patients (motor deficit in 5 cases; speech deficit in 3 cases). CONCLUSION: Resection of eloquent brain area tumors using intraoperative neurophysiological monitoring enables complete resection of the tumor at a low risk of persistent neurological deficits, which ultimately improves the patient's life prognosis.

[Impact of a pneumonia prevention protocol on the results of treatment in patients in the acute period of stroke].

To evaluate the efficiency of introducing a local protocol for preventing pneumonia in the acute period of stroke, the authors analyzed the results of treating 52 intensive care unit patients who had a higher than 75% pneumonia risk. These patients were divided into 2 groups: a control group (before introduction of the protocol) (n = 25) and a study group (after introduction of the protocol (n = 27). A retrospective analysis showed a significant reduction in the total incidence of pneumonia (56 and 18.5%; p < 0.05), in the incidence of ventilator-associated pneumonia (65/1000 and 19/1000 days of artificial ventilation (AV); p < 0.05), total mortality (48.0 and 14.8%; p < 0.01) and mortality among patients on AV (78.6 and 21.1%; p < 0.005).

[Experience in the use of regional methods of anesthesia in oncological and gynecological surgeries]. / Opyt primeneniia regionarnykh metodov anestezii pri oncoginekologicheskikh operatsiiakh.

The block loco-regional methods of anesthesia as applied to onco-gynecology surgery were used in 1310 patients with the predominant 2nd stage ASA risk. The best results (efficiency, safety, convenience) were ensured with spinal anesthesia by intraoperative sedative analgesia (micro-units of midazolam, propofol and ketamine) and by a 0.3 mg single-unit intramuscular injection of buprenorphine (made at the final surgery stage) that prevented a severe postoperative pain syndrome, which was later arrested by an "on-demand" intramuscular injection of peri pheral-action analgetics (ketoprofen or methamezol--therapeutic dose).