Psychopathological manifestations of multiple meningiomas in the right hemisphere

The paper gives the data available in the literature on meningiomas and their psychopathological manifestations that occupy a central position in the clinical picture in almost every 5 patients with these tumors. The authors provide a clinical and psychopathological analysis of a female patient with multiple meningiomas in the right hemisphere: a giant meningioma in the posterior third of the falx, a large meningioma in the temporal region, and three small meningiomas in the frontal and parietal regions. The disease started as headache; however, psychopathological symptoms remained missed by physicians, such as emotional lability; personality changes leading to family dissension; lower criticism; spatial orientation problems; hypomnesia; left-sided visual inattention,occurred in parallel. Surgical treatment was performed by stages: the two largest meningiomas were removed at an 11-day interval, which presented a means of observing psychopathological changes after each operation. It is concluded that greater attention should be given to the psychopathological manifestations of the disease, which is important to make a primary diagnosis and to define further treatment policy

Анестезиологические аспекты удаления гормонально-активных каротидных хемодектом: клиническое наблюдение и обзор литературы

The article describes a clinical case - the resection of the hormone- active tumor of the carotid glomus. The hormonal activity of the tumor was suspected based on data of the patient's history, (malignant arterial hypertension with sharp rises in arterial tension, episodes of the increased arterial tension during mechanical impact on the tumor) and hemodynamic parameters during surgery (heart rhythm disturbances after induction of anesthesia and pronounced hypertensive reactions when manipulating the tumor tissue). The article reviews publications on anesthetic support during the resection of hormone-active chemodectomas.Detection of typical clinical signs such as hypertension, tachycardia, fever, headaches, etc. in the history of patients with chemodectoma may suggest hormonal activity of the tumor. Biochemical tests that determine the level of catecholamines and their breakdown products can confirm the diagnosis. When planning surgery, the anesthesiologist should be prepared for the development of the relevant complications. Hypertension, as the most frequent complication, should be prevented by preoperative adrenergic blockers and treated intraoperatively with short-acting antihypertensive drugs. After exclusion of the tumor from the bloodstream, it is necessary to prepare for the development of hypotension.Приведено описание клинического наблюдения ‒ удаления гормонально-активной опухоли каротидного гломуса. Предположение о гормональной активности опухоли сделано на основании данных анамнеза (злокачественная артериальная гипертензия с кризовым течением, эпизоды подъема артериального давления при механическом воздействии на опухоль) и особенностей гемодинамики во время операции (нарушения ритма сердца после индукции анестезии и выраженные гипертензивные реакции при манипуляции на ткани опухоли). В обсуждении представлен обзор литературы, посвященный анестезиологическому обеспечению удаления гормонально-активных хемодектом.Выявление характерных клинических симптомов в виде гипертензии, тахикардии, лихорадки, головных болей и др. в анамнезе пациентов с хемодектомами могут натолкнуть на мысль о гормональной активности опухоли. Биохимические тесты, определяющие уровень катехоламинов и продуктов их распада, позволяют подтвердить диагноз. При планировании операции анестезиолог должен быть готов к развитию характерных осложнений. Гипертензия, как самое частое осложнение, должна быть профилактирована назначением адреноблокаторов перед операцией и купирована короткодействующими гипотензивными препаратами интраоперационно. После выключения опухоли из кровотока следует быть готовым к развитию гипотонии

Эноксапарин-индуцированная гепатотоксичность: клинические наблюдения и обзор литературы

Low molecular weight heparins, in particular enoxaparin, have a wide range of applications, including prevention and treatment of deep vein thrombosis.  The most common adverse effects of these drugs are bleeding and thrombocytopenia, but a clinician should be aware of another less common but not less important adverse effect such as an elevated transaminase level. In 2019, we observed two cases of enoxaparin-induced hepatotoxicity. In the first one, enoxaparin 0.4 ml subcutaneously twice a day was prescribed to a 40-year-old woman as a bridge therapy to discontinue warfarin before elective surgery. In the second case, a 27-year-old man received enoxaparin 0.4 ml subcutaneously twice a day for the prevention of deep vein thrombosis. The elevation of transaminase level for more than 3 times above the norm was noted in both patients which required discontinuation of the drug.Низкомолекулярные гепарины, в частности эноксапарин, имеют широкий спектр показаний к применению, включая профилактику и лечение тромбоза глубоких вен. Назначая эноксапарин, любой практикующий врач помнит о возможности развития кровотечений или тромбоцитопении, однако мало кто осведомлен о таком побочном эффекте, как повышение уровня печеночных трансаминаз. В 2019 г. мы столкнулись с двумя случаями эноксапарин-индуцированной гепатотоксичности. В первом наблюдении женщине 40 лет был назначен эноксапарин в дозе 0,4 мл подкожно 2 раза в сутки в качестве мост-терапии для отмены варфарина перед плановым хирургическим вмешательством, во втором – мужчина 27 лет получал эноксапарин в дозе 0,4 мл подкожно 2 раза в сутки для профилактики тромбоза глубоких вен. У обоих пациентов отмечалось повышение уровня печеночных трансаминаз больше 3 верхних пределов нормы, что потребовало отмены препарата

Defining activities in neurovascular microsurgery training : entrustable professional activities for vascular neurosurgery

Background Entrustable professional activities (EPAs) represent an assessment framework with an increased focus on competency-based assessment. Originally developed and adopted for undergraduate medical education, concerns over resident ability to practice effectively after graduation have led to its implementation in residency training but yet not in vascular neurosurgery. Subjective assessment of resident or fellow performance can be problematic, and thus, we aim to define core EPAs for neurosurgical vascular training. Methods We used a nominal group technique in a multistep interaction between a team of experienced neurovascular specialists and a medical educator to identify relevant EPAs. Panel members provided feedback on the EPAs until they reached consent. Results The process produced seven core procedural EPAs for vascular residency and fellowship training, non-complex aneurysm surgery, complex aneurysm surgery, bypass surgery, arteriovenous malformation resection, spinal dural fistula surgery, perioperative management, and clinical decision-making. Conclusion These seven EPAs for vascular neurosurgical training may support and guide the neurosurgical society in the development and implementation of EPAs as an evaluation tool and incorporate entrustment decisions in their training programs.Peer reviewe

Anesthetic aspects of the resection of hormone-active carotid chemodectomas: a clinical case and literature review

The article describes a clinical case - the resection of the hormone- active tumor of the carotid glomus. The hormonal activity of the tumor was suspected based on data of the patient's history, (malignant arterial hypertension with sharp rises in arterial tension, episodes of the increased arterial tension during mechanical impact on the tumor) and hemodynamic parameters during surgery (heart rhythm disturbances after induction of anesthesia and pronounced hypertensive reactions when manipulating the tumor tissue). The article reviews publications on anesthetic support during the resection of hormone-active chemodectomas.Detection of typical clinical signs such as hypertension, tachycardia, fever, headaches, etc. in the history of patients with chemodectoma may suggest hormonal activity of the tumor. Biochemical tests that determine the level of catecholamines and their breakdown products can confirm the diagnosis. When planning surgery, the anesthesiologist should be prepared for the development of the relevant complications. Hypertension, as the most frequent complication, should be prevented by preoperative adrenergic blockers and treated intraoperatively with short-acting antihypertensive drugs. After exclusion of the tumor from the bloodstream, it is necessary to prepare for the development of hypotension

Unsolved triumph: Cannons and causes of the second Russian turmoil

© 2019, Universidad del Zulia. All rights reserved. The article presents an original analysis of the main aspects of Russian turmoil of the early XX century via deep study of the traditions of peasant studies and introduction into scientific circulation of new archival documents. In result, the prolonged self-reflection, which already began to look like a nirvana, caused rotting of the discourse, which was not experiencing the invigorating influence of criticism and beneficial influence of dynamics. In conclusion, the picture of community-based revolution, it is rather unsightly. But it is reduced to a banal robbery or to the notorious peasant element, senseless and ruthless Russian revolt

Unsolved triumph: Cannons and causes of the second Russian turmoil

© 2019, Universidad del Zulia. All rights reserved. The article presents an original analysis of the main aspects of Russian turmoil of the early XX century via deep study of the traditions of peasant studies and introduction into scientific circulation of new archival documents. In result, the prolonged self-reflection, which already began to look like a nirvana, caused rotting of the discourse, which was not experiencing the invigorating influence of criticism and beneficial influence of dynamics. In conclusion, the picture of community-based revolution, it is rather unsightly. But it is reduced to a banal robbery or to the notorious peasant element, senseless and ruthless Russian revolt

Cognitive functions in patients with stenotic lesions of the great arteries of the head before and after carotid endartectomy

Objective: to study higher mental functions (HMF) in patients with stenotic lesion of the brachiocephalic arteries (BCA) before and after carotid endarterectomy (CE). Patients and methods. Prior to and following CE, 97 patients underwent neurological examination, neuropsychological syndrome analysis described by A.R. Luria, evaluation using the Wexler verbal working memory scale, Stroop word-digital test, and Schulte test. BCA ultrasound duplex scanning and cerebral perfusion were made over time. Results. Preoperative neuropsychological study revealed abnormalities in 98% of the patients. There was most common bilateral frontal dysfunction and deep structural pathology, which were more pronounced in persons above 50 years of age and in the presence of mixed BCA stenosis. Stenosis-associated unilateral parietal and temporal dysfunctions were more frequently registered. Within 30 days after CE, the maximum HMF changes were found in patients having unilateral stenosis. There was ameliorated dysfunction of the structures blood is supplied to which by an operated vessel and the vertebrobasilar system. Poststroke patients were found to have a significant intraoperative HMF reduction in the early rehabilitation period of stroke. The syndromes having common and local mechanisms of development and different topic sites were identified among the short-term and reversible HMF impairments. Conclusion. Despite heterodirectional HMF changes in the early period after BCA reconstructive operations, the positive cognitive functional changes in all the patients at 30 days of CE confirm the rationale for and efficiency of surgical intervention