Non-invasive detection of intracranial pressure in clinical practice (review of literature)

The aim of the research was to summarize the results of the researches of preoperative diagnostics of intracranial hypertension using data of modern publications and also to determine possible algorithm of diagnostic measures before planning neurosurgical approach at the treatment of intracranial injuries. We analyzed Russian and foreign literary sources for 30 years using key words and search system PubMed. The analysis shows that the search of methods of non-invasive control of intracranial pressure is still actual because of the risk of severe complications of using invasive methods. The most accurate and clinically valuable method of evaluation and prediction of intracranial hypertension in patients with severe craniocerebral injury amongst all considered non-invasive methods (evaluation of tympanic membrane displacement, cochlear microphonia, evaluation of blood pressure in retinal veins, transcranial Doppler imaging, evaluation of optic nerve diameter etc.) is an evaluation of optic nerve diameter using data of ultrasonography, CT imaging and magnetic resonance tomography. Given the fact of operator-dependence of ultrasonography and known limitation for using magnetic resonance tomography in patients with severe craniocerebral injury, CT-data of the optic nerve diameter more than 5,8 mm available from plain preoperative examination can be considered as a reliable prognostic index of development of intracranial hypertension while planning p operative approach

PECULARITIES OF COMPOSITION OF PROTEIN FRACTIONS AND ACUTE-PHASE LIQUOR PROTEINS IN NORM AND AT COMPRESSION SYNDROME OF LUMBAR REGION OF SPINE

Peculiarities of composition of protein fractions and acute-phase liquor proteins as the indications of activity of immunologic liquor reactions were studied by biochemical method in 15 patients without neurological diseases and. in 36 patients with compression syndrome of lumbar region of spine. On this base the set of standard data of acute-phase liquor proteins was developed. The Peculiarities of composition of acute-phase liquor proteins in patients with compression syndrome of lumbar region of spine were itemized. Interrelation of changes of acute-phase liquor proteins in norm. and. at compression syndrome of nervous structure of lumbar region of spine was determined

Epidemiological assessment of the prevalence of coxarthrosis according to reports from medical organizations

Background. Coxarthrosis prevalence rates are necessary to assess the socio-economic significance of this pathology and to calculate the need for endoprosthetics. Information about the provision of medical care to patients with coxarthrosis is presented in the reports of various medical organizations, but in state statistical reports at the regional level this nosological form is not taken into account as a separate line.The aim. To estimate the prevalence of coxarthrosis based on the combined use of medical records from various sources in a region with a specialized clinic for prosthetics of large joints.Materials and methods. A retrospective descriptive epidemiological study based on materials from the Irkutsk region for 10 years (2008–2017) was carried out. Three main sources of data on patients with coxarthrosis were used: continuous and randomized samples based on population visits to polyclinics (n = 24 029), information from the bureau of medical and social expertise on disability (n = 19 081) and information from a specialized clinic on total hip arthroplasty (THAP) (n = 6227). The dynamics of indicators by years, the distribution of patients by sex, age and groups of disabilities have been analyzed. Regional indicators of incidence and prevalence of coxarthrosis were calculated based on extrapolation of sample data.Results. The following average annual regional indicators for patients with coxarthrosis were calculated: primary visits to polyclinics (incidence) – 73.8 (71.9–75.7) with a frequency of visits 1.9 times a year, the frequency of THAP operations – 3,3 (3,0÷3,6), disability – 10.1 (10.0÷10.3). The median age of patients at the initial visit was 61 years (Q1 = 46; Q3 = 76). The proportion of men among different groups of patients ranged from 41 to 44%, the proportion of disabled people among patients of the polyclinic and surgical hospital – from 45.2 to 47.1%. The estimated prevalence of coxarthrosis among the adult population was 413.5 (410,6÷416,4) / 10000.Conclusions. The epidemiological analysis algorithm described in the article is proposed as the first stage in assessing the social and economic significance of coxarthrosis and the regional need for arthroplasty of large joints

Historical aspects of the problem of surgical treatment of hemorrhagic stroke. The role of intracranial pressure in the choice of treatment tactics (review of literature)

This article provides a literature review of the past 60 years, conducted using keywords through the PubMed Internet resource, dedicated to the methods of surgical treatment of hemorrhagic stroke. The existing published results of clinical studies do not allow us to draw unambiguous conclusions about the superiority of conservative or neurosurgical treatment in relation to the functional recovery of patients. There is a statistical significance of the advantages of surgery based on the prevention of dislocation syndrome, control of intracranial hypertension, and prevention or at least reduction of the effect of blood and its degradation products on the surrounding healthy tissue. However, large randomized controlled trials have failed to demonstrate this benefit in terms of mortality or functional outcome.There are two main areas of hemorrhagic stroke surgery – open surgery and minimally invasive methods. The practice of open surgery is associated with high trauma rates, as well as with certain risks and complications. However, craniotomy is a lifesaving measure in critical situations with signs of persistent increased intracranial pressure leading to neurological impairment. The ability to control intracranial pressure provides a chance for the choice of more optimal tactics of surgical treatment.Today, the gold standard for intracranial pressure monitoring is the installation of invasive intraventricular or intraparenchymal transducers. The method is appreciated for its accuracy, however, there are a number of disadvantages in the form of the possibility of hemorrhagic and infectious complications, as well as the high cost of the sensor itself, which limits its routine use. The inability to measure intracranial pressure before surgery causes an unreasonable expansion of indications for choosing an open method of surgery, which reduces the possibility of a better functional outcome.All of these points make it urgent to search for a non-invasive method for measuring intracranial pressure, which would contribute to the timely choice of a surgical method without the danger of worsening the clinical outcome

CONTRIBUTION OF T.D. ZYRYANOVA TO THE STUDY OF THE PROBLEM OF PELVIC BONES INJURIES AND ASSOCIATED COMPLICATIONS

The article presents the results of scientific fundamental and applies researches of Tatyana Dmitrievna Zyryanova on the problem of study of pelvic bones and coxal cavity fractures complicated and non-complicated with bladder, urethra and rectum injuries. T.D. Zyryanova studied and systematized problems on the statistics of this incapacitating pathology, its clinic and diagnostics. She determined indications for conservative and surgical treatment of certain pelvic bones and pelvic waist injury and an algorithm of rehabilitation measures after the treatment. T.D. Zyryanova and co-authors proposed system of transport immobilization at the injuries of pelvic bones and concomitant injuries of internals of cavity of the lesser pelvis

OPTIMIZATION OF SURGICAL TREATMENT OF CHRONIC POSTTRAUMATIC ANTEROMEDIAL INSTABILITY OF SHOULDER JOINT AT THE BONE DEFECT OF ARTICULAR PROCESS OF THE SCAPULA

Main reason of shoulder joint instability is bone defect of scapula cavity. The number of unsatisfactory outcomes after surgical treatment is still high. The aim. of the research was to improve surgical technique of treatment of patients with chronic posttraumatic anteromedial instability of shoulder joint at the bone defect of articular process of the scapula. Open controlled prospective randomized research was carried out in the clinics of SCRRS SB RAMS. Clinical effectiveness of proposed medical technology was proved on the basis of analysis of operative treatment of 34 patients during 6 months after the operation. We used Bristow - Latarjet bone plastics for comparison

Several aspects of conservative treatment of patients with cervical osteochondrosis

The aim of the research was to develop an algorithm of complex conservative treatment of patients with cervical osteochondrosis. We examined and provided conservative treatment to 40 patients with cervical osteochondrosis in periods 1-11 with severe pain syndrome. The treatment was mainly aimed at pain management. For this purpose, we assigned non-steroidal anti-inflammatory drugs (NSA1D) to the patients. NSA1D are the most effective medicinal agents, first of all due to their analgesic effect. Also, the treatment included physiotherapy and acupuncture. As a result of the treatment, neurological manifestations were reduced. Number of cervicalgia cases decreased from 12 (before the treatment) to 6 (after the treatment), number of cervical cranialgia cases - from 12 to 7, number of cervicobrachialgia cases - from 16 to 8 correspondingly. Developed complex of conservative treatment measures allows to obtain successful treatment results in most cases. 1t is important to note that proposed treatment regimen is available, simple and can be applied in all neurological and neurosurgical units and hospitals

IMMUNOLOGIC PARAMETERS OF LIQUOR AT THE FORMING OF EPIDURAL FIBROSIS IN LUMBAR SEGMENT OF SPINE

Concentrations and composition of acute-phase proteins in liquor were studied by method of ultraviolet absorption. spectroscopy in 15 patients without neurological diseases and. in 25 patients with syndrome of spinal canal structures compression. The role of acute-phase proteins of liquor in forming of epidural fibrosis was determined. Significance of denaturated proteins of liquor in pathogenesis of syndrome of compression of lumbar segment of spine was revealed

Formation of Adhesive Arachnoiditis with Epidural Fibrosis as a Cause of Repeated Surgical Interventions (Clinical Case)

The work presents a rare clinical case of adhesive arachnoiditis, which developed against the background of epidural fibrosis during repeated surgical interventions. The cicatricial adhesion in the epidural space is formed in 100% of cases after surgery and is a frequent cause of intraoperative complications during repeated surgical interventions (bleeding, damage to the spinal cord and the dura mater with subsequent outflow of cerebrospinal fluid) and, therefore, an unsatisfactory result of surgical treatment with the formation of constant pain of various intensity, pseudomeningocele, commissural arachnoiditis, etc. The cicatricial adhesion in the epidural space is the main reason for the development of failed back surgery syndrome (FBSS), which today is an important and unresolved problem in spinal surgery. The epidural, as well as the subdural and subarachnoid space of the operated spinal motor segment of the spinal canal can be involved in the cicatricial adhesion, as it is shown in our clinical example. In this regard, it is important to prevent the development of the cicatricial adhesion in the epidural space during primary spinal surgeries, since with the increase in life expectancy of the population and increase in surgical activity during spinal surgeries, the patient can be operated repeatedly. Consequently, the question arises of preventing the formation of the cicatricial adhesion in 100% of cases with each surgical intervention, since the formed cicatricial adhesion in the epidural space does not have effective methods of conservative and surgical treatment and worsens favorable and satisfactory forecasts of surgical treatment for repeated surgical interventions

Enzyme systems activity and connective tissue metabolism as pathogenetic factors of spinal stenosis (literature review)

A characteristic feature of stenosis process of the spinal canal is the destruction of elastin and fibrosis of the extracellular matrix, as well as hypertrophy and ossification of the ligamentum flavum. Proven participation in these processes of genes CTGF, PDGF-BB, TGF-ß, Il-6, TNF-α, MMPs, TIMPs, etc. Potent inducer of extracellular deposition of collagen in hypertrophies ligamentum flavum is TGF-ß; GDF-5 has osteogenic effect, increases the activity of alkaline phosphatase and the expression of osteocalcin, induces mineralization; FGFR3 gene expression contributes to the closure of synchondroses and merging of centers of ossification, contributing to excess synthesis of bone tissue, etc. Local or a systemic effect on the expression of these genes may be effective to prevent progression of the disease. Predisposition to stenosis and responsiveness to therapy is genetically determined and is expressed in individual differences in metabolic status. A very important role in the pathobiochemistry of connective tissue are the processes of acetylation by regulating the expression of essential genes that affects all intracellular processes and especially in the fibrogenesis. An imbalance of acetylation may lead to excessive synthesis of collagen, accelerating the growth of connective tissue, disruption of lipid homeostasis. Therefore, it is relevant as the definition of NAT2 polymorphism and phenotypic identification of the rate of acetylation in the population, as well as finding relationships with various pathological processes. Meaningful impact on the processes of acetylation may contribute to the sanogenesis. The information presented in the review is important for the formation of a new perspective on the pathogenesis of stenosis process in the spinal canal and can contribute to the development of new approaches to treatment