Predictive accuracy of cardiac risk indices for cardiovascular complications in patients undergoing noncardiac surgery

Objective: To compare predictive accuracy of the American Society of Anesthesiologists (ASA) score and various cardiac risk indices for perioperative cardiovascular (CV) complications in patients undergoing noncardiac surgery.Materials and methods: We examined 243 patients (148 men and 95 women) aged 45 to 84 (66 [60-71] years) prior to their elective oncological and vascular surgery. We assessed patients using the ASA physical status classification system, Revised Cardiac Risk Index (RCRI), Gupta Myocardial Infarct or Cardiac Arrest (MICA) calculator, and Khoronenko cardiac risk index and analyzed perioperative CV complications.Results: We detected complications in 30 (12.3%) patients, with 3 (1.24%) of them having 2 concomitant CV complications. One death (0.41%) was registered. The MICA risk calculator had the highest predictive value (AUC ROC = 0.753). Risk scores over 0.95% discriminated patients with perioperative CV complications with sensitivity and specificity of 73.3% and 67.45%, respectively.Conclusions: We recommend using the MICA risk calculator to predict perioperative CV complications following elective oncological and vascular surgery

COMPARISON OF THE EFFECTIVENESS OF GENE THERAPY AND STANDARD CONSERVATIVE THERAPY FOR PATIENTS WITH CHRONIC LOWER LIMB ISCHEMIA DUE TO ATHEROSCLEROSIS

OBJECTIVE. The objective is to compare the effectiveness of standard conservative therapy (SCT) and the complex therapy with preparation based on VEGF165 gene in patients with the stage II of chronic lower limb ischemia according to Fontaine classification during 5 years.MATERIAL AND METHODS. In total, 92 patients were enrolled in the study. Patients were divided into 2 groups (n=46 for each group). In the first group, patients got only conservative therapy and in the second group, patients were received SCT in combination with injection of gene drug into the ischemic limb muscles.RESULTS. The using of gene therapy in complex management in patients with the stage II of chronic lower limb ischemia led to significant increasing of the average pain-free walking distance (up to 500 %) (p=0.007). In addition, there were 65 % of the patients in the second group obtaining a significant and moderate improvement. By contrast, there was only 3 % of cases in the first group having similar results with standard therapy. Only gene therapy has statistically significance in the secondary parameters of treatment efficiency.CONCLUSION. The efficiency of complex treatment with gene therapy in patients with the stage II of ch ronic lower limb ischemia for 5 years exceeds significantly the efficiency of standard conservative therapy

REMOTE 3-YEAR RESULTS OF APPLICATION OF «INDIRECT» WAYS OF REVASCULARIZATION IN PATIENTS WITH CHRONIC ISCHEMIA OF LOWER EXTREMITIES

There are several ways of «indirect» revascularization such as revascularizated osteotrepanation of shinbone and lumbar sympathectomy (LS) for treatment of patients with chronic ischemia of lower extremities. They appeared to be sufficiently effective for the patients with II stage of the disease. Patients with critical ischemia (III stage) had persistent positive results after lumbar sympathectomy during 3-year period only in 33% of cases and using revacularized osteotrepnation - 46%. The difference in efficacy of treatment using LS and standard conservative therapy is statistically low significant, so that isn’t allowed recommending the sympathectomy for treatment of III stage ischemia. The method of revascularizated osteotrepanation of shinbone showed a reliably better result, therefore this way is reasonable to apply in surgery in case of III stage ischemia

The clinical and neurophysiological characteristics of the deja vu phenomenon in epilepsy

Objective: to study the clinical and neurophysiological characteristics of the deja vu phenomenon in epilepsy. Patients and methods. The manifestations of the dВjЕ vu phenomenon were compared in 154 examinees in two groups: 1) 139 healthy individuals and 2) 25 patients with epilepsy (mean age 25.17±9.19 years; women, 63.2%) The characteristics of the phenomenon were determined, by questioning the examinees; 12—16-hour ambulatory electroencephalogram (EEG) monitoring was made. Results. The deja vu phenomenon occurred with cryptogenic and symptomatic focal epilepsy with equal frequency; however, the phenomenon was also seen in the idiopathic generalized form of the latter and could be concurrent virtually with any types of seizures and observed as an individual seizure and in the structure of a partial and secondarily generalized seizure. In epileptic patients, the main clinical characteristics of the deja vu vu phenomenon are its frequency, fear before its onset, and emotional coloring. The most important criterion is a change in the characteristics of deja vu vu: prolongation, more frequencies, and the emergence of negative emotions. On EEG, the phenomenon was characterized by the onset of polyspike activity in the right temporal leads and, in some cases, ended with slow-wave, theta-delta activity in the right hemisphere

DEREALIZATION DISORDERS IN EPILEPSY

Derealization is mental disorder, manifested in a feeling of unreality and strangeness of the surrounding real world, a form of impairment of consciousness. The most common and recognizable such disorder is the phenomenon of «déjà vu» – deja vu (DV). Objective: to study the clinical and diagnostic value derealization disorders (DD) in epilepsy. Materials and Methods: the total study group was 152 persons (mean age 25,17±9,19; 63,2% of women). The phenomena of derealization were compared in groups of healthy subjects (n = 139) and patients with epilepsy (n = 23). Patients were interviewed on the DV characteristics and long-term (12-16 hours) ambulatory EEG monitoring was conducted. Results: the same frequency of DV in patients with cryptogenic and symptomatic focal epilepsy was demonstrated. DV could be combined with any types of seizures, it could be aura of a seizure or own seizure. The main clinical characteristics that differentiate DV in healthy from DV in patients with epilepsy are: frequency, fear of the onset DV and emotional coloring. The most important criterion is the dynamic characteristics of the DV: elongation increased the appearance of negative emotions. The DV phenomenon characterized in EEG by start with polyspiking activity in the right temporal leads and, in some cases, ended by slow wave, theta-delta activity in the right hemispher

Russian experience with perampanel in routine clinical practice

Objective: to generalize the Russian experience with perampanel (PER) in routine clinical practice; to do this, the results of its use as an adjuvant partial epilepsy medication were retrospectively assessed. The study is still in progress now; therefore, the paper gives its preliminary results. Patients and methods. The investigation included 52 patients with drug-resistant partial epilepsy. Their mean age was 28.92±14.02 years (asmall number of the patients had not attained the age of 12 years); the proportion of men was 56%; the disease duration was over 10 years (69.2%); symptomatic epilepsy was in 76.9% with an epileptic focus being in the frontal (46.2%) and temporal (44.2%) regions. PER was prescribed to the majority (71.2%) of patients after three previous therapy lines. The baseline monthly rates of all types of seizures were 127.29±82.29; those of generalized seizures were 6.72±1.90.Results and discussion. After addition of PER to therapy just within the first month, there was a significant reduction in the frequency of all types of seizures to 52.06±29.26 per month (Sign test; p = 0.00001) and in that of secondary generalized seizures to 3.71±1.71 (Sign test; p=0.00001). The duration of PER administration was more than 6 months in the overwhelming majority of cases. In 58% of the patients, the frequency of seizures decreased by more than 50% (respondents). The lack of all types of seizures was noted in 8%; that of only secondary generalized seizures was in 31%. Adverse  events were observed in 30.1% of the patients (aggression in 11.5% and somnolence in 9.6%; others were seen more rarely). The dose of PER was decreased because of side effects in 7 (13.5%) patients; the drug was discontinued in 4 (7.7%). The mean dose of PER for adults was as high as 6 mg