Anaplastic glioma is one of the most dangerous and serious brain tumors. Modern microsurgery, radiation, chemotherapy, and other all-encompassing therapeutic techniques can lead to inadequate clinical treatment results for gliomas. High dose re-irradiation with concurrent chemotherapy is a workable treatment option for patients with metastases and recurrent anaplastic gliomas, even when significant treatment volumes are being employed to target non-enhancing tumor components. The issue of glioma metastasis is likewise unsettled and poorly understood. Single serial observations of high-grade glioma metastases are reported in the international literature, with glioblastoma accounting for the majority of these cases. Isolated cases of anaplastic glioma metastasis have been recorded in the majorit y of observations.
{"title":"Results of treatment of recurrent growth and metastasis of anaplastic gliomas","authors":"S. K. Badu, А. N. Nazarbekov","doi":"10.33920/med-01-2312-03","DOIUrl":"https://doi.org/10.33920/med-01-2312-03","url":null,"abstract":"Anaplastic glioma is one of the most dangerous and serious brain tumors. Modern microsurgery, radiation, chemotherapy, and other all-encompassing therapeutic techniques can lead to inadequate clinical treatment results for gliomas. High dose re-irradiation with concurrent chemotherapy is a workable treatment option for patients with metastases and recurrent anaplastic gliomas, even when significant treatment volumes are being employed to target non-enhancing tumor components. The issue of glioma metastasis is likewise unsettled and poorly understood. Single serial observations of high-grade glioma metastases are reported in the international literature, with glioblastoma accounting for the majority of these cases. Isolated cases of anaplastic glioma metastasis have been recorded in the majorit y of observations.","PeriodicalId":447580,"journal":{"name":"Vestnik nevrologii, psihiatrii i nejrohirurgii (Bulletin of Neurology, Psychiatry and Neurosurgery)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139176722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Non-vestibular schwannomas constitute a rare group of intracranial tumors. Surgical removal is associated with technical difficulties and a high risk of permanent dysfunction of the cranial nerves involved. Radiosurgery is an alternative method for treating intracranial tumors of various locations. Purpose of the study. Analysis of the effectiveness of radiosurgical treatment of patients with non-vestibular schwannomas. Material and methods. From March 2018 to February 2023, 19 patients with tumors of the cranial nerves, excluding vestibular schwannomas, were treated at the Gamma Clinic. One facial nerve tumor was removed and verified as a malignant nerve sheath tumor 6 months after SRS. The mean age of the patients was 46.6 years, with 6 men and 13 women. The average tumor volume before treatment was 4.0 cm3 (0.1–8.4 cm3). Radiation treatment was carried out using the Leksell Gamma Knife Perfexion. The analysis of tumor dynamics after irradiation was carried out by volumetric comparison on control MRIs. Neurological dynamics were assessed based on a face-to-face examination of the patients or based on the results of a telephone survey during remote follow-up. Results. Fifteen patients were available for outcome assessment. Median follow-up was 37.9 months (CI 95 % 12.1–50.2). In 10 patients, a decrease in tumor was noted at the time of the last MRI; in 5 patients, an increase in tumor volume was detected. Thus, tumor growth control was achieved in 10 out of 15 cases (66.6 %). Clinical symptoms regressed or remained stable in 11 cases; in other 4 patients, a temporary increase in clinical symptoms was noted due to transient post-radiation tumor enlargement, with a further decrease in symptoms to the initial level due to tumor reduction or steroid therapy. There was no persistent aggravation of symptoms after SRS. Conclusions: Stereotactic radiosurgery is an effective and safe treatment method for non-vestibular schwannomas. Given the phenomenon of post-radiation pseudoprogression, longer follow-up is required to assess tumor growth control.
{"title":"Early results of radiosurgical treatment of patients with non-vestibular intracranial schwannomas","authors":"S. R. Ilyalov","doi":"10.33920/med-01-2312-02","DOIUrl":"https://doi.org/10.33920/med-01-2312-02","url":null,"abstract":"Non-vestibular schwannomas constitute a rare group of intracranial tumors. Surgical removal is associated with technical difficulties and a high risk of permanent dysfunction of the cranial nerves involved. Radiosurgery is an alternative method for treating intracranial tumors of various locations. Purpose of the study. Analysis of the effectiveness of radiosurgical treatment of patients with non-vestibular schwannomas. Material and methods. From March 2018 to February 2023, 19 patients with tumors of the cranial nerves, excluding vestibular schwannomas, were treated at the Gamma Clinic. One facial nerve tumor was removed and verified as a malignant nerve sheath tumor 6 months after SRS. The mean age of the patients was 46.6 years, with 6 men and 13 women. The average tumor volume before treatment was 4.0 cm3 (0.1–8.4 cm3). Radiation treatment was carried out using the Leksell Gamma Knife Perfexion. The analysis of tumor dynamics after irradiation was carried out by volumetric comparison on control MRIs. Neurological dynamics were assessed based on a face-to-face examination of the patients or based on the results of a telephone survey during remote follow-up. Results. Fifteen patients were available for outcome assessment. Median follow-up was 37.9 months (CI 95 % 12.1–50.2). In 10 patients, a decrease in tumor was noted at the time of the last MRI; in 5 patients, an increase in tumor volume was detected. Thus, tumor growth control was achieved in 10 out of 15 cases (66.6 %). Clinical symptoms regressed or remained stable in 11 cases; in other 4 patients, a temporary increase in clinical symptoms was noted due to transient post-radiation tumor enlargement, with a further decrease in symptoms to the initial level due to tumor reduction or steroid therapy. There was no persistent aggravation of symptoms after SRS. Conclusions: Stereotactic radiosurgery is an effective and safe treatment method for non-vestibular schwannomas. Given the phenomenon of post-radiation pseudoprogression, longer follow-up is required to assess tumor growth control.","PeriodicalId":447580,"journal":{"name":"Vestnik nevrologii, psihiatrii i nejrohirurgii (Bulletin of Neurology, Psychiatry and Neurosurgery)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139176418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. Cheboksarov, M. V. Petrova, O. V. Ryzhova, O. P. Artyukov
The main obstacle to understanding sepsis is an excessively broad definition of this disease, which covers an extensive set of clinical and pathophysiological signs. Different combinations of these traits can naturally combine into phenotypes that have different degrees of risk of an adverse outcome, and may respond differently to treatment. Scientific work on the determination of phenotypes has focused mainly on patients in the intensive care unit. In addition, there have been no prospective or retrospective studies on the classification and phenotyping of sepsis patients in a chronic critical condition. Most likely, this is due to the fact that the term «chronic critical patient» is quite novel and has recently been widely covered in both Russian and foreign scientific literature. The purpose of this work is the theoretical determination of phenotypic groups for chronic critical patients. Methods and materials: The search for Russian publications was carried out in the database on the RSCI website, and foreign publications were searched in the PubMed and Google Scholar databases in the period of 1998–2022. When analyzing the PubMed database, the query «sepsis phenotype» resulted in 62,371 links. The works on the keywords «chronic critical illness» were also studied. The publications describing the sepsis phenotypes, the diagnosis of sepsis and septic shock, as well as the clinical picture of a chronic critical condition (illness) were analyzed, with a total of 45 scientific articles. Discussion: It is also worth noting that the study by C. Seymour, latent class analysis, and other works devoted to the treatment of sepsis consider a large number of mainly non-surgical patients, without dividing them by the main nosology and foci of infection. Meanwhile, the main axis of neurohumoral immunity, i.e. the brain — gastrointestinal tract, is disrupted in chronic critical patients. These patients, as well as patients undergoing repeated sepsis caused by a nosocomial infection, are not considered separately in any of the studies. Furthermore, neither the study by C. Seymour, nor the latent class analysis examines any instrumental method for assessing the infection focus (radiography or computed tomography of the lungs). Much attention is paid to the acid-base state of patients, but the state of the main buffer systems is not described in terms of the presence of concomitant or competing diseases, and an indication of an increase in creatinine and blood urea nitrogen can only indirectly indicate kidney dysfunction and, as a consequence, a disorder in the bicarbonate bufer system. Conclusions: Based on the above, the basic classifications for patients with sepsis in an acute state should be updated for chronic critical patients with host response options, taking into account the peculiarities of the immune system. Moreover, it is recommendable to phenotype chronic critical patients separately, considering the localization of brain damage, since patients w
{"title":"The possibility of phenotyping patients with sepsis in a chronic critical condition","authors":"D. Cheboksarov, M. V. Petrova, O. V. Ryzhova, O. P. Artyukov","doi":"10.33920/med-01-2312-10","DOIUrl":"https://doi.org/10.33920/med-01-2312-10","url":null,"abstract":"The main obstacle to understanding sepsis is an excessively broad definition of this disease, which covers an extensive set of clinical and pathophysiological signs. Different combinations of these traits can naturally combine into phenotypes that have different degrees of risk of an adverse outcome, and may respond differently to treatment. Scientific work on the determination of phenotypes has focused mainly on patients in the intensive care unit. In addition, there have been no prospective or retrospective studies on the classification and phenotyping of sepsis patients in a chronic critical condition. Most likely, this is due to the fact that the term «chronic critical patient» is quite novel and has recently been widely covered in both Russian and foreign scientific literature. The purpose of this work is the theoretical determination of phenotypic groups for chronic critical patients. Methods and materials: The search for Russian publications was carried out in the database on the RSCI website, and foreign publications were searched in the PubMed and Google Scholar databases in the period of 1998–2022. When analyzing the PubMed database, the query «sepsis phenotype» resulted in 62,371 links. The works on the keywords «chronic critical illness» were also studied. The publications describing the sepsis phenotypes, the diagnosis of sepsis and septic shock, as well as the clinical picture of a chronic critical condition (illness) were analyzed, with a total of 45 scientific articles. Discussion: It is also worth noting that the study by C. Seymour, latent class analysis, and other works devoted to the treatment of sepsis consider a large number of mainly non-surgical patients, without dividing them by the main nosology and foci of infection. Meanwhile, the main axis of neurohumoral immunity, i.e. the brain — gastrointestinal tract, is disrupted in chronic critical patients. These patients, as well as patients undergoing repeated sepsis caused by a nosocomial infection, are not considered separately in any of the studies. Furthermore, neither the study by C. Seymour, nor the latent class analysis examines any instrumental method for assessing the infection focus (radiography or computed tomography of the lungs). Much attention is paid to the acid-base state of patients, but the state of the main buffer systems is not described in terms of the presence of concomitant or competing diseases, and an indication of an increase in creatinine and blood urea nitrogen can only indirectly indicate kidney dysfunction and, as a consequence, a disorder in the bicarbonate bufer system. Conclusions: Based on the above, the basic classifications for patients with sepsis in an acute state should be updated for chronic critical patients with host response options, taking into account the peculiarities of the immune system. Moreover, it is recommendable to phenotype chronic critical patients separately, considering the localization of brain damage, since patients w","PeriodicalId":447580,"journal":{"name":"Vestnik nevrologii, psihiatrii i nejrohirurgii (Bulletin of Neurology, Psychiatry and Neurosurgery)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139176837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. V. Kolomentsev, A. V. Kolomentseva, I. Litvinenko, P. A. Polezhaev, M. S. Yaroslavtseva, A. A. Kirpichenko, A. V. Ryabtsev
The article presents modern views on structure and functioning of dopaminergic structures of the brain and spinal cord and their role in mechanisms of antinociception, formation, and chronification of different pain syndrome types. The paper provides a detailed description of analgesic effects of various dopamine receptors in the structures of the CNS (the spinal cord, ventral tegmental area, periaqueductal gray, corpus striatum, nucleus accumbens, hypothalamus, and medial prefrontal cortex) which function as the dopaminergic antinociceptive system. The results of numerous investigations carried out on models of neuropathic pain syndrome have shown that D2 dopamine receptors possess the greatest analgesic activity. Their antinociceptive mechanism of action is effectuated at the level of substantia gelatinosa of the spinal cord and cerebral dopaminergic structures. D1‑like receptors have lower analgesic activity and different mechanisms of action depending on localization within the brain. High availability of D2/D3 receptors in corpus striatum is indicative of a low synaptic level of endogenous dopamine and leads to reduction of pain perception threshold. On the contrary, low availability of D2/D3 receptors results in the increase of pain perception threshold. The dopaminergic antinociceptive system is characterized by a modulating effect on other neurotransmitter systems participating in nociception and antinociception. An important mechanism of antinociception of dopaminergic structures is connected with superadditivity and synergism of D2 receptors with opioid receptors. Proven participation of dopaminergic structures in pain perception and analgesia demonstrates a potential possible application of D2‑receptors agonists as an adjuvant method for achieving a greater effect in therapeutic multimodal schemes of analgesia.
{"title":"Dopamine antinociceptive system","authors":"S. V. Kolomentsev, A. V. Kolomentseva, I. Litvinenko, P. A. Polezhaev, M. S. Yaroslavtseva, A. A. Kirpichenko, A. V. Ryabtsev","doi":"10.33920/med-01-2311-03","DOIUrl":"https://doi.org/10.33920/med-01-2311-03","url":null,"abstract":"The article presents modern views on structure and functioning of dopaminergic structures of the brain and spinal cord and their role in mechanisms of antinociception, formation, and chronification of different pain syndrome types. The paper provides a detailed description of analgesic effects of various dopamine receptors in the structures of the CNS (the spinal cord, ventral tegmental area, periaqueductal gray, corpus striatum, nucleus accumbens, hypothalamus, and medial prefrontal cortex) which function as the dopaminergic antinociceptive system. The results of numerous investigations carried out on models of neuropathic pain syndrome have shown that D2 dopamine receptors possess the greatest analgesic activity. Their antinociceptive mechanism of action is effectuated at the level of substantia gelatinosa of the spinal cord and cerebral dopaminergic structures. D1‑like receptors have lower analgesic activity and different mechanisms of action depending on localization within the brain. High availability of D2/D3 receptors in corpus striatum is indicative of a low synaptic level of endogenous dopamine and leads to reduction of pain perception threshold. On the contrary, low availability of D2/D3 receptors results in the increase of pain perception threshold. The dopaminergic antinociceptive system is characterized by a modulating effect on other neurotransmitter systems participating in nociception and antinociception. An important mechanism of antinociception of dopaminergic structures is connected with superadditivity and synergism of D2 receptors with opioid receptors. Proven participation of dopaminergic structures in pain perception and analgesia demonstrates a potential possible application of D2‑receptors agonists as an adjuvant method for achieving a greater effect in therapeutic multimodal schemes of analgesia.","PeriodicalId":447580,"journal":{"name":"Vestnik nevrologii, psihiatrii i nejrohirurgii (Bulletin of Neurology, Psychiatry and Neurosurgery)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139231853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E. N. Kabaeva, A. G. Gushchina, S. A. Krylova, N. V. Nozdryukhina, A. Pozdnyakov
Introduction. Cognitive impairment after a stroke remains one of the leading causes of disability. Despite the introduction of new methods of treatment, diagnosis, and prevention of acute vascular diseases, more than 50 % of patients experience cognitive disorders after a stroke, a third of which reach a severe degree of dementia. The purpose of the study is to identify and assess risk factors for the development of cognitive impairment disorders in patients after a stroke and evaluate the impact of anxiety and depressive phenomena on their course. Materials and methods. The combined retro-prospective study included 40 patients with mild stroke according to the NIHSS. The diagnosis of stroke in all subjects was verified based on the results of MSCT of the brain. All patients underwent a comprehensive clinical and laboratory monitoring: a general examination; an assessment of neurological and functional status; an assessment of cognitive functions and mental status by MMSE scale and the Frontal Assessment Battery; an assessment of anxiety-depressive disorders by the Spielberger State-Trait Anxiety Inventory, the Beck Depression Inventory, and the Hamilton Rating Scale. The influence of individual risk factors on the development of cognitive impairment was evaluated. Results. More than 80 % of the patients with mild stroke in the acute period experienced a decrease in cognitive functions, while 62 % of the subjects showed signs of frontal dementia of varying severity. In the presence of high comorbidity with forms of the circulatory system pathologies (hypertension, diabetes, atrial fibrillation, coronary heart disease), there was a high frequency of both frontal dementia (in 87 % of the patients), and a decrease in cognitive functions on the MMSE scale (67 % of cases). All patients were diagnosed with depression, and half of them — with severe depression. 80 % of the patients with severe depression had severe cognitive changes on the MMSE scale, and 75 % had severe frontal dysfunction. Conclusion. Thus, high vascular comorbidity and the presence of anxiety and depressive disorders are significant risk factors for the development of cognitive impairment after a stroke. In this regard, measures aimed at their timely detection, treatment, and correction will make it possible to effectively reduce the incidence of post-stroke cognitive impairment, which, in turn, will improve the quality of life not only for the patients themselves but also for their relatives.
{"title":"Features of cognitive impairment and anxiety-depressive disorders in patients in the acute period of stroke","authors":"E. N. Kabaeva, A. G. Gushchina, S. A. Krylova, N. V. Nozdryukhina, A. Pozdnyakov","doi":"10.33920/med-01-2311-07","DOIUrl":"https://doi.org/10.33920/med-01-2311-07","url":null,"abstract":"Introduction. Cognitive impairment after a stroke remains one of the leading causes of disability. Despite the introduction of new methods of treatment, diagnosis, and prevention of acute vascular diseases, more than 50 % of patients experience cognitive disorders after a stroke, a third of which reach a severe degree of dementia. The purpose of the study is to identify and assess risk factors for the development of cognitive impairment disorders in patients after a stroke and evaluate the impact of anxiety and depressive phenomena on their course. Materials and methods. The combined retro-prospective study included 40 patients with mild stroke according to the NIHSS. The diagnosis of stroke in all subjects was verified based on the results of MSCT of the brain. All patients underwent a comprehensive clinical and laboratory monitoring: a general examination; an assessment of neurological and functional status; an assessment of cognitive functions and mental status by MMSE scale and the Frontal Assessment Battery; an assessment of anxiety-depressive disorders by the Spielberger State-Trait Anxiety Inventory, the Beck Depression Inventory, and the Hamilton Rating Scale. The influence of individual risk factors on the development of cognitive impairment was evaluated. Results. More than 80 % of the patients with mild stroke in the acute period experienced a decrease in cognitive functions, while 62 % of the subjects showed signs of frontal dementia of varying severity. In the presence of high comorbidity with forms of the circulatory system pathologies (hypertension, diabetes, atrial fibrillation, coronary heart disease), there was a high frequency of both frontal dementia (in 87 % of the patients), and a decrease in cognitive functions on the MMSE scale (67 % of cases). All patients were diagnosed with depression, and half of them — with severe depression. 80 % of the patients with severe depression had severe cognitive changes on the MMSE scale, and 75 % had severe frontal dysfunction. Conclusion. Thus, high vascular comorbidity and the presence of anxiety and depressive disorders are significant risk factors for the development of cognitive impairment after a stroke. In this regard, measures aimed at their timely detection, treatment, and correction will make it possible to effectively reduce the incidence of post-stroke cognitive impairment, which, in turn, will improve the quality of life not only for the patients themselves but also for their relatives.","PeriodicalId":447580,"journal":{"name":"Vestnik nevrologii, psihiatrii i nejrohirurgii (Bulletin of Neurology, Psychiatry and Neurosurgery)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139228992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
L. Ngankam, A. M. Fomin, A. B. Mikhalchuk, E. V. Guseva
Fractures and dislocation fractures of C5‑Th1 vertebrae account for about 70 % of all spinal injuries. The article describes a case history of the successful treatment of the fractured C6 vertebra by means of spinal fusion with an autogenous bone. The SCT (spiral computed tomography) and MRI (magnetic resonance imaging), performed for diagnostic purposes, showed a splintered fracture of the C6 vertebra with spinal cord compression and mild spinal cord swelling. The clinical picture indicated acute pain in the cervical spine, quadriplegia, and functional disorder of the pelvic organs caused by the severity and level of the injury. The patient underwent two simultaneous surgeries: during the first operation, a fragment of autologous bone from the left iliac wing was taken, and during the second surgery, spinal fusion of C5‑C7 with autologous bone and fixation with a titanium plate were performed. After the interventions, the follow-up SCT of the C-spine showed no signs of spinal cord compression, and the wedge-shaped deformation of the vertebral canal was remedied. No displacement of the vertebral bodies and changes in the height of the vertebrae and vertebral discs is present. After treatment, the patient will undergo long-term rehabilitation measures. The obtained result proves the efficacy of autobone spinal fusion with anterior low-profile titanium plate fixation with four screws. Due to correct and timely medical care provided to the patient, all of the treatment objectives (minimizing secondary injuries of the spinal cord and ensuring optimal conditions for recovery of neurons and axons in the area of disturbed blood supply, spine stabilization) were accomplished.
C5-Th1椎体骨折和脱位骨折约占所有脊柱损伤的70%。本文介绍了一例通过自体骨脊柱融合术成功治疗 C6 椎体骨折的病例。为诊断目的而进行的螺旋计算机断层扫描（SCT）和磁共振成像（MRI）显示，C6脊椎骨碎裂性骨折伴有脊髓压迫和轻度脊髓肿胀。临床表现为颈椎急性疼痛、四肢瘫痪以及因损伤的严重程度和水平而导致的盆腔器官功能紊乱。患者同时接受了两次手术：第一次手术从左侧髂骨翼取了一块自体骨碎片，第二次手术用自体骨进行了 C5-C7 脊柱融合，并用钛板进行了固定。手术后，随访的 C 型脊柱 SCT 显示没有脊髓受压的迹象，椎管的楔形变形也得到了纠正。椎体没有移位，椎骨和椎间盘的高度也没有变化。治疗后，患者将接受长期康复措施。所获得的结果证明了自体骨脊柱融合术与前路低位钛板四螺钉固定的疗效。由于为患者提供了正确和及时的医疗护理，所有治疗目标（最大限度地减少脊髓的二次损伤、确保血液供应紊乱区域的神经元和轴突恢复的最佳条件、脊柱稳定）均已实现。
{"title":"Efficacy of spinal fusion in treatment of splintered fracture of the C6 vertebral body with spinal cord compression in an adolescent (case history)","authors":"L. Ngankam, A. M. Fomin, A. B. Mikhalchuk, E. V. Guseva","doi":"10.33920/med-01-2311-04","DOIUrl":"https://doi.org/10.33920/med-01-2311-04","url":null,"abstract":"Fractures and dislocation fractures of C5‑Th1 vertebrae account for about 70 % of all spinal injuries. The article describes a case history of the successful treatment of the fractured C6 vertebra by means of spinal fusion with an autogenous bone. The SCT (spiral computed tomography) and MRI (magnetic resonance imaging), performed for diagnostic purposes, showed a splintered fracture of the C6 vertebra with spinal cord compression and mild spinal cord swelling. The clinical picture indicated acute pain in the cervical spine, quadriplegia, and functional disorder of the pelvic organs caused by the severity and level of the injury. The patient underwent two simultaneous surgeries: during the first operation, a fragment of autologous bone from the left iliac wing was taken, and during the second surgery, spinal fusion of C5‑C7 with autologous bone and fixation with a titanium plate were performed. After the interventions, the follow-up SCT of the C-spine showed no signs of spinal cord compression, and the wedge-shaped deformation of the vertebral canal was remedied. No displacement of the vertebral bodies and changes in the height of the vertebrae and vertebral discs is present. After treatment, the patient will undergo long-term rehabilitation measures. The obtained result proves the efficacy of autobone spinal fusion with anterior low-profile titanium plate fixation with four screws. Due to correct and timely medical care provided to the patient, all of the treatment objectives (minimizing secondary injuries of the spinal cord and ensuring optimal conditions for recovery of neurons and axons in the area of disturbed blood supply, spine stabilization) were accomplished.","PeriodicalId":447580,"journal":{"name":"Vestnik nevrologii, psihiatrii i nejrohirurgii (Bulletin of Neurology, Psychiatry and Neurosurgery)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139234389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
N.M. Zalutskaya, I.I. Khyanikyaynen, A. A. Dmitryakova
In order to study the types of attitude towards the disease and quality of life (QoL) in elderly patients with mild vascular dementia (MVD) living in the conditions of the psychoneurological institution Social Service House “Severnoye Izmailovo” in Moscow, there were 2 study groups: the patients with the clinical debut of the novel coronavirus infection (NCVI) of 6 months +/– 1 month with the recovery outcome (n=65; 33 men, 32 women) and those who did not have COVID-19 (hospital control group; n=67; 34 men, 33 women). The mean age of the studied patients was 73.05±3.48 years. The age and sex composition of the two groups was homogeneous (p>0.05). Emotional disorders were investigated using the Cornell Scale for Depression in Dementia (CSDD); cognitive disorders – by means of the Montreal Cognitive Assessment (MoCA); QoL – by the Quality of Life in Alzheimer's Disease scale (QoL-AD): QoL self-assessment (QoL-AD-SR (self-rating)) and proxy QoL rating (QoL-AD-PR (proxy rating)); the type of attitude towards the disease – by the TATD scale (Wasserman L.I. et al., 2005). It was found that COVID-19 aggravates cognitive deficits in patients with MVD (according to MoCA 20.80±0.59 /21.40±0.78 points; p<0.05) in the absence of depression (according to CSDD 1.52±0.50 / 1.52±0.84 points in the group of the patients after NCVI / hospital control group, respectively; p>0.05). In the patients after COVID-19, a correlation was found between the proxy QoL rating and the severity of cognitive dysfunction according to the MoCA (R= – 0.28), while in the hospital control group – between the proxy QoL rating and the severity of depressive manifestations (R= – 0.33). The first group of the patients was characterized by a mixed type of attitude to the disease and intrapsychic maladaptation (the neurasthenic type ranked first at 16.03±8.29 / 9.34±5.03 points), while the second group had a diffuse type of attitude to the disease and interpsychic maladaptation (the sensitive type ranked first at 10.31±5.71 / 14.90±7.62 points by the TATD scale among the elderly patients with MVD who have / have not undergone NCVI; p<0.05). The revealed patterns can contribute to the optimization of personalized models of medical and psychological rehabilitation of elderly patients with MVD living in closed-type care facilities.
{"title":"Attitude to the disease and quality of life in elderly patients with mild vascular dementia after the novel coronavirus infection","authors":"N.M. Zalutskaya, I.I. Khyanikyaynen, A. A. Dmitryakova","doi":"10.33920/med-01-2311-01","DOIUrl":"https://doi.org/10.33920/med-01-2311-01","url":null,"abstract":"In order to study the types of attitude towards the disease and quality of life (QoL) in elderly patients with mild vascular dementia (MVD) living in the conditions of the psychoneurological institution Social Service House “Severnoye Izmailovo” in Moscow, there were 2 study groups: the patients with the clinical debut of the novel coronavirus infection (NCVI) of 6 months +/– 1 month with the recovery outcome (n=65; 33 men, 32 women) and those who did not have COVID-19 (hospital control group; n=67; 34 men, 33 women). The mean age of the studied patients was 73.05±3.48 years. The age and sex composition of the two groups was homogeneous (p>0.05). Emotional disorders were investigated using the Cornell Scale for Depression in Dementia (CSDD); cognitive disorders – by means of the Montreal Cognitive Assessment (MoCA); QoL – by the Quality of Life in Alzheimer's Disease scale (QoL-AD): QoL self-assessment (QoL-AD-SR (self-rating)) and proxy QoL rating (QoL-AD-PR (proxy rating)); the type of attitude towards the disease – by the TATD scale (Wasserman L.I. et al., 2005). It was found that COVID-19 aggravates cognitive deficits in patients with MVD (according to MoCA 20.80±0.59 /21.40±0.78 points; p<0.05) in the absence of depression (according to CSDD 1.52±0.50 / 1.52±0.84 points in the group of the patients after NCVI / hospital control group, respectively; p>0.05). In the patients after COVID-19, a correlation was found between the proxy QoL rating and the severity of cognitive dysfunction according to the MoCA (R= – 0.28), while in the hospital control group – between the proxy QoL rating and the severity of depressive manifestations (R= – 0.33). The first group of the patients was characterized by a mixed type of attitude to the disease and intrapsychic maladaptation (the neurasthenic type ranked first at 16.03±8.29 / 9.34±5.03 points), while the second group had a diffuse type of attitude to the disease and interpsychic maladaptation (the sensitive type ranked first at 10.31±5.71 / 14.90±7.62 points by the TATD scale among the elderly patients with MVD who have / have not undergone NCVI; p<0.05). The revealed patterns can contribute to the optimization of personalized models of medical and psychological rehabilitation of elderly patients with MVD living in closed-type care facilities.","PeriodicalId":447580,"journal":{"name":"Vestnik nevrologii, psihiatrii i nejrohirurgii (Bulletin of Neurology, Psychiatry and Neurosurgery)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139228052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
G. I. Antonov, V. A. Manukovskiy, G. Е. Chmutin, I. I. Ivanov, S. Timonin, A. O. Kelin
Introduction. Spinal column and spinal cord injuries are one of the most severe types of trauma. The paper presents the results of examination and treatment of 80 patients with combat spinal column and spinal cord injuries treated in the neurosurgical department of the FSBI National Medical Research Center for High Medical Technologies — A. A. Vishnevsky Central Military Clinical Hospital. Purpose. To analyze the structure of incoming wounded patients and the results of treatment of patients with combat spinal injury in the conditions of a multidisciplinary medical center. Materials and methods. The paper analyzes the results of treatment of 80 patients with combat spinal column and spinal cord injuries treated in the Neurosurgery Center, FSBI National Medical Research Center for High Medical Technologies — A. A. Vishnevsky Central Military Clinical Hospital. The inclusion criteria were the radiological signs of combat spinal injury upon admission to the hospital. Upon admission, all patients underwent pan CT scan, their somatic and neurological status was assessed, and laboratory parameters were evaluated. Gunshot wounds were found in 66.25 % (n=53) of the patients, and blunt combat injuries to the spine were found in 33.75 % (n=17). Concomitant injuries were sustained by 81.25 % (n=65) of the studied patients. Prior to admission to the Neurosurgery Center, neurosurgical care was provided to some of the wounded. Spinal surgery was performed in 30.0 % (n=24) of the cases, and 56.25 % (n=45) were operated on for injuries to other anatomical regions and organ systems. Results. 69 % (n=55) of the patients underwent neurosurgical treatment. The indication for surgery in 56.4 % (n=31) of the patients was instability in the spinal motion segment (SMS). Both one-stage (anterior or posterior stabilization) and two-stage operations consisting of posterior and anterior approaches, including with the use of minimally invasive techniques (8 cases), were performed. In 23 patients, foreign body removal was performed, including by means of videoimage endoscopy (in 5 cases). On average, the wounded had an operation on the 5th day after the injury. At discharge, motor neurological improvement or complete recovery was seen in 21.1 % (n=16) of the patients, while motor disorders remained at the initial level in 78.9 % (n=60). Sensory disorders decreased in 13.1 % (n=10), while 84.2 % (n=64) showed no improvement in sensory level. There was a significant decrease in the intensity of the pain syndrome. However, the number of patients with neuropathic pain decreased slightly (41 patients among all the examined at discharge versus 42 at admission). The functions of the pelvic organs were restored in 8.25 % (n=7) of the patients. At the stage of treatment in the specialized center, 49 % (n=39) of the patients had complications in different organ systems. The mortality rate was 2.5 % (n=2).
{"title":"Analysis of treatment outcomes in patients with combat spinal column and spinal cord injuries","authors":"G. I. Antonov, V. A. Manukovskiy, G. Е. Chmutin, I. I. Ivanov, S. Timonin, A. O. Kelin","doi":"10.33920/med-01-2311-06","DOIUrl":"https://doi.org/10.33920/med-01-2311-06","url":null,"abstract":"Introduction. Spinal column and spinal cord injuries are one of the most severe types of trauma. The paper presents the results of examination and treatment of 80 patients with combat spinal column and spinal cord injuries treated in the neurosurgical department of the FSBI National Medical Research Center for High Medical Technologies — A. A. Vishnevsky Central Military Clinical Hospital. Purpose. To analyze the structure of incoming wounded patients and the results of treatment of patients with combat spinal injury in the conditions of a multidisciplinary medical center. Materials and methods. The paper analyzes the results of treatment of 80 patients with combat spinal column and spinal cord injuries treated in the Neurosurgery Center, FSBI National Medical Research Center for High Medical Technologies — A. A. Vishnevsky Central Military Clinical Hospital. The inclusion criteria were the radiological signs of combat spinal injury upon admission to the hospital. Upon admission, all patients underwent pan CT scan, their somatic and neurological status was assessed, and laboratory parameters were evaluated. Gunshot wounds were found in 66.25 % (n=53) of the patients, and blunt combat injuries to the spine were found in 33.75 % (n=17). Concomitant injuries were sustained by 81.25 % (n=65) of the studied patients. Prior to admission to the Neurosurgery Center, neurosurgical care was provided to some of the wounded. Spinal surgery was performed in 30.0 % (n=24) of the cases, and 56.25 % (n=45) were operated on for injuries to other anatomical regions and organ systems. Results. 69 % (n=55) of the patients underwent neurosurgical treatment. The indication for surgery in 56.4 % (n=31) of the patients was instability in the spinal motion segment (SMS). Both one-stage (anterior or posterior stabilization) and two-stage operations consisting of posterior and anterior approaches, including with the use of minimally invasive techniques (8 cases), were performed. In 23 patients, foreign body removal was performed, including by means of videoimage endoscopy (in 5 cases). On average, the wounded had an operation on the 5th day after the injury. At discharge, motor neurological improvement or complete recovery was seen in 21.1 % (n=16) of the patients, while motor disorders remained at the initial level in 78.9 % (n=60). Sensory disorders decreased in 13.1 % (n=10), while 84.2 % (n=64) showed no improvement in sensory level. There was a significant decrease in the intensity of the pain syndrome. However, the number of patients with neuropathic pain decreased slightly (41 patients among all the examined at discharge versus 42 at admission). The functions of the pelvic organs were restored in 8.25 % (n=7) of the patients. At the stage of treatment in the specialized center, 49 % (n=39) of the patients had complications in different organ systems. The mortality rate was 2.5 % (n=2).","PeriodicalId":447580,"journal":{"name":"Vestnik nevrologii, psihiatrii i nejrohirurgii (Bulletin of Neurology, Psychiatry and Neurosurgery)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139232199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anaplastic glioma is a rare disease with an unfavorable prognosis. Currently, guidelines do not provide clear recommendations for the optimal treatment of patients with anaplastic glioma, necessitating the use of individual case series to guide clinical decisionmaking. Therefore, this study aimed to review the clinical management of anaplastic gliomas, including long-term follow-up (catamnesis) and complications. Using a retrospective approach, we analyzed patients with anaplastic glioma who were treated in our institution, either with or without concomitant chemotherapy, from early 2000 until 2021. Overall survival and progressionfree survival were calculated from the time of diagnosis until death and from the initiation of radiation therapy until the detection of disease progression through MRI. Our findings indicate that the combination of surgery, radiotherapy, and chemotherapy yielded the maximum benefit in the treatment of anaplastic glioma. However, managing this aggressive tumor remains challenging, despite continuous advancements in therapeutic options. Optimal management necessitates a multidisciplinary approach and a comprehensive understanding of potential complications arising from both the disease itself and its treatment.
{"title":"Results of complex treatment of anaplastic glioma","authors":"S. K. Badu","doi":"10.33920/med-01-2311-02","DOIUrl":"https://doi.org/10.33920/med-01-2311-02","url":null,"abstract":"Anaplastic glioma is a rare disease with an unfavorable prognosis. Currently, guidelines do not provide clear recommendations for the optimal treatment of patients with anaplastic glioma, necessitating the use of individual case series to guide clinical decisionmaking. Therefore, this study aimed to review the clinical management of anaplastic gliomas, including long-term follow-up (catamnesis) and complications. Using a retrospective approach, we analyzed patients with anaplastic glioma who were treated in our institution, either with or without concomitant chemotherapy, from early 2000 until 2021. Overall survival and progressionfree survival were calculated from the time of diagnosis until death and from the initiation of radiation therapy until the detection of disease progression through MRI. Our findings indicate that the combination of surgery, radiotherapy, and chemotherapy yielded the maximum benefit in the treatment of anaplastic glioma. However, managing this aggressive tumor remains challenging, despite continuous advancements in therapeutic options. Optimal management necessitates a multidisciplinary approach and a comprehensive understanding of potential complications arising from both the disease itself and its treatment.","PeriodicalId":447580,"journal":{"name":"Vestnik nevrologii, psihiatrii i nejrohirurgii (Bulletin of Neurology, Psychiatry and Neurosurgery)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139227781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Kolycheva, V. Shimanskiy, S. V. Tanyashin, L. R. Gabrielyan, M. A. Akulov, L. A. Sidneva
Rationale: Modern literature contains a large number of works assessing the effectiveness of surgical treatment of hemifacial spasm (HFS). However, only a few present an analysis of results with a follow-up period of more than 6 months. This study demonstrates the results of patient follow-up for 12 months or more.Purpose of the study: Identification of possible patterns of outcomes of HFS surgical treatment during a follow-up period of 12 months or more. Methods: The study included 84 patients who underwent vascular decompression of the facial nerve between 2018 and 2022. The duration of the history of hemifacial spasm in the presented patients ranged from 1 year to 18 years with an average of 5 years and 10 months. In order to assess treatment results, the Sindou et al. scale was used. Results: At discharge, 92.8 % of the patients underwent successful surgery; of these, the majority (73.8 %) were completely free of spasticity symptoms, which corresponded to «0» on Sindou scale. Six months after surgical treatment, the distribution of the patients was somewhat different from that in the early postoperative analysis. In contrast to the early assessment of spasticity, the delayed assessment showed that 67.8 % of the operated patients out of the total number of the patients did not have clinical signs of hemifacial spasm 6 months after the intervention. 17.9 % had symptoms corresponding to grade I, that is, rare twitching of the facial muscles, which did not significantly affect the patient’s well-being. 5.9 % of the patients had grade II clinical condition, and 8.4 % had grade III, when the result was assessed as «unsatisfactory». One year after surgery, we did not observe significant differences from the data presented after 6 months: 67.1 % still had no symptoms of spasticity, 18.75 % corresponded to grade I, 6.25 % — to grade II, and 7.8 % of the patients presented in the study belonged to grade III. Conclusion: Today, vascular decompression is the most effective method of HFS etiopathogenetic treatment. The data obtained during the study show that a result that satisfies both the doctor and the patient is achievable in most cases, and our study confirms this. After all, one of the most important aspects of such surgery, performed not as a life-saving operation, but in order to improve the patient’s quality of life, is the maximum possible reduction in the likelihood of developing complications that subsequently affect the lives of such patients.
理论依据：现代文献中有大量评估半面肌痉挛（HFS）手术治疗效果的著作。然而，只有少数文献对随访 6 个月以上的结果进行了分析。本研究展示了患者随访 12 个月或更长时间的结果：研究目的：确定随访 12 个月或更长时间的 HFS 手术治疗结果的可能模式。研究方法研究纳入2018年至2022年期间接受面神经血管减压术的84例患者。这些患者的半面痉挛病史持续时间从 1 年到 18 年不等，平均为 5 年 10 个月。为了评估治疗效果，采用了辛杜等人的量表。结果显示出院时，92.8%的患者成功接受了手术，其中大多数（73.8%）完全摆脱了痉挛症状，相当于辛杜量表中的 "0 "分。手术治疗六个月后，患者的分布情况与术后早期的分析结果有些不同。与痉挛的早期评估不同，延迟评估显示，67.8%的手术患者在干预治疗 6 个月后没有出现半面痉挛的临床症状。17.9%的患者出现了 I 级症状，即罕见的面部肌肉抽搐，但对患者的健康影响不大。5.9%的患者临床症状为 II 级，8.4%为 III 级，即结果被评估为 "不满意"。手术一年后，我们没有发现与 6 个月后的数据有明显差异：67.1%的患者仍然没有痉挛症状，18.75%的患者属于 I 级，6.25%的患者属于 II 级，7.8%的患者属于 III 级。结论目前，血管减压是治疗 HFS 病因的最有效方法。研究中获得的数据表明，在大多数情况下都能取得令医生和患者都满意的效果，我们的研究也证实了这一点。毕竟，这种手术不是为了挽救生命，而是为了提高病人的生活质量，其最重要的一点是最大限度地降低并发症的发生几率，因为并发症会影响病人的生活。
{"title":"Middle-term results of surgical treatment of patients with hemifacial spasm using Sindou classification","authors":"M. Kolycheva, V. Shimanskiy, S. V. Tanyashin, L. R. Gabrielyan, M. A. Akulov, L. A. Sidneva","doi":"10.33920/med-01-2311-12","DOIUrl":"https://doi.org/10.33920/med-01-2311-12","url":null,"abstract":"Rationale: Modern literature contains a large number of works assessing the effectiveness of surgical treatment of hemifacial spasm (HFS). However, only a few present an analysis of results with a follow-up period of more than 6 months. This study demonstrates the results of patient follow-up for 12 months or more.Purpose of the study: Identification of possible patterns of outcomes of HFS surgical treatment during a follow-up period of 12 months or more. Methods: The study included 84 patients who underwent vascular decompression of the facial nerve between 2018 and 2022. The duration of the history of hemifacial spasm in the presented patients ranged from 1 year to 18 years with an average of 5 years and 10 months. In order to assess treatment results, the Sindou et al. scale was used. Results: At discharge, 92.8 % of the patients underwent successful surgery; of these, the majority (73.8 %) were completely free of spasticity symptoms, which corresponded to «0» on Sindou scale. Six months after surgical treatment, the distribution of the patients was somewhat different from that in the early postoperative analysis. In contrast to the early assessment of spasticity, the delayed assessment showed that 67.8 % of the operated patients out of the total number of the patients did not have clinical signs of hemifacial spasm 6 months after the intervention. 17.9 % had symptoms corresponding to grade I, that is, rare twitching of the facial muscles, which did not significantly affect the patient’s well-being. 5.9 % of the patients had grade II clinical condition, and 8.4 % had grade III, when the result was assessed as «unsatisfactory». One year after surgery, we did not observe significant differences from the data presented after 6 months: 67.1 % still had no symptoms of spasticity, 18.75 % corresponded to grade I, 6.25 % — to grade II, and 7.8 % of the patients presented in the study belonged to grade III. Conclusion: Today, vascular decompression is the most effective method of HFS etiopathogenetic treatment. The data obtained during the study show that a result that satisfies both the doctor and the patient is achievable in most cases, and our study confirms this. After all, one of the most important aspects of such surgery, performed not as a life-saving operation, but in order to improve the patient’s quality of life, is the maximum possible reduction in the likelihood of developing complications that subsequently affect the lives of such patients.","PeriodicalId":447580,"journal":{"name":"Vestnik nevrologii, psihiatrii i nejrohirurgii (Bulletin of Neurology, Psychiatry and Neurosurgery)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139233021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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