[Clinical evaluation of the influence of certain initial status parameters on the development of type 2 diabetes mellitus in patients with metabolic syndrome].

Type 2 diabetes mellitus (DM2) is one of the clinical outcomes of metabolic syndrome (MS). We observed 201 patients with MS during 10 years. At the study end-point 144 (71.9%) of them developed DM2. The study aimed at evaluating effect of initial parameter of MS on the rate of DM2 development. Results of correlation analysis show that the rate of DM2 development depends in the first place on the patients' age, severity of abdominal obesity, vicious habits and their combination with disturbed lipid metabolism, sympatho-adrenal disbalance , and arterial hypertension rather than on disordered carbohydrate metabolism at the onset of the disease.

[Neuroophthalmological aspects of benign intracranial hypertension].

Benign intracranial hypertension (BICH) is characterized by elevated spinal fluid pressure in the absence of space-occupying lesion in the skull, dilated cerebral ventricles, significant neurological disorders, and altered spinal fluid composition. Forty-nine patients with a female predominance were examined. Their age ranged from 4 to 52 years (median 39 years). The most common predictors of BICH were overweight, endocrine disorders, and cerebral sinus thrombosis. Ophthalmoscopically, the patients were found to have early, moderate, and significant papilledema, and secondary optic atrophy. Examination of visual functions revealed these or those disturbances of visual acuity and/or field of vision in 43 of the 49 patients. The incidence and degree of visual disturbances depended on the stage of papilledema. Timely diagnosis and treatment in patients with BICH allows the development of visual disturbances to be prevented in them.

[Congestive optic disks in the brain massive lesions].

To study the specific features of development of papilledema (PE) in brain space-occupying lesions, the authors made a statistical analysis of neuroophthalmologic symptoms in 962 patients with brain tumors, colloid cysts of the third ventricle and cholesteatomas, who had been examined at the Research Institute of Neurosurgery during a calendar year. PE was identified in 30.8% of the patients. The frequency of PE was ascertained to depend on histological pattern, space-occupying lesion site, and age. Visual disturbances in PE were observed in more than a third of patients and manifested themselves as both diminished visual acuity and defects in the field of vision. The frequency and degree of visual deficit depended on the stage of PE.

Compensatory mechanisms in patients with benign intracranial hypertension syndrome.

135 patients from 16 to 59 years old with benign intracranial hypertension syndrome (BIH) due to postinflammatory processes (A), venous outflow disorders (V), and endocrinological disorders (G) were investigated by CT, MRI, MRI-Ag, carotid-Ag and constant pressure infusion test. All the obtained data were analyzed and possible relationships between the parameters of CSF dynamics and the clinical data were evaluated. Correlative analysis of the obtained data was performed and the main mechanisms of compensation of BIH syndrome were established. In patients of group A disturbances of CSF absorption system with high level of CSF outflow resistance (R) and secondary elevation of brain elastance (EL) were common. In patients of this group venous disorders were of secondary nature and appeared in a later period of the disease. The patients of group V showed increased intrasinus pressure, which correlated to high R and EL. In patients of group G we found the signs of CSF hyper-production with high level of EL. Increased R in patients of this group seemed to be a secondary reaction. The investigation identified the main stages of evolution and compensation of hypertension in the patients with BIH syndrome. The obtained data may be used in optimizing the conservative therapy and indications for lumboperitoneal shunting.

[Quantitative assessment of the cerebrospinal fluid dynamic parameters in patients with the "benign" intracranial hypertension syndrome. 2]. / Kolichestvennaia otsenka parametrov u bol'nykh s sindromom "dobrokachestvennoi" vnutricherepnoi gipertenzii. Chast' 2.

The development of the benign intracranial hypertensive syndrome was shown to be followed by changes in liquorodynamic parameters and elastic properties of the brain. In 99% of patients, the baseline liquor pressure was elevated by 1.5-2.5 times as compared to normal values. Resistance of liquor resorption was enhanced in 82% of cases, suggesting impaired normal liquor outflow. The increased brain elasticity gradient suggests the exhaustion of cerebrospinal compensatory potentialities and correlates with the increased liquor resorption resistance. A correlation analysis of liquorodynamic parameters by taking into account clinical signs yielded a pathogenetic scheme of the development of the benign intracranial hypertensive syndrome.

[Elastic properties of the cerebrospinal system and cerebrospinal fluid dynamics in intracranial hypertension and normotensive hydrocephalus in adults]. / Elasticheskie svoistva tserebrospinal'noi sistemy i likvorodinamika pri vnutricherepnoi gipertenzii i normotenzivnoi gidrotsefalii u vzroslykh.

Time course of changes of the CSF and the elastic properties of the cerebrospinal system were studied in 25 patients with normotensive hydrocephalus and in 26 patients suffering from benign intracranial hypertension. In 66% of cases with the normotensive hydrocephalus syndrome and in 60% of those with benign intracranial hypertension CSF resorption resistance and the elasticity gradient increased. Shunting operations proved effective in such cases.

[Methodologic problems in studies of pressure in the venous sinuses of the brain]. / Metodicheskie voprosy issledovaniia davleniia v venoznykh sinusakh golovnogo mozga.

The adequacy of the indirect method for the liquorodynamic evaluation of intrasinusal pressure has been established. It was found that in patients with parasagittal meningiomas intrasinusal pressure does not depend on the size of the tumour and its relation to the superior sagittal sinus, or on intracranial hypertension (up to 28 mm Hg). In the phase of decompensation of intracranial hypertension the effective pressure of resorption increases. The quantitative characteristics of venous cerebral circulation and of liquorodynamics is of importance in evaluating the condition of compensatory mechanisms of the cerebrospinal system in various forms of neurosurgical pathology.

[Mechanisms of hydrocephalus development in patients with parasagittal meningiomas]. / O mekhanizmakh vozniknoveniia gidrotsefalii u bol'nykh s parasagittal'nymi meningiomami.

The work deals with the identification of the main mechanisms of hydrocephalus development in patients with parasagittal meningiomas who, besides the additional volume in the cranial cavity, have some degree of venous drainage disorders as a rule. This leads to the development of intracranial hypertension and often to hydrocephalus. From the analysis of the quantitative parameters characterizing the viscous-resilient properties of the brain, the c.s.f. changes, the intrasinus pressure according to the phase of the clinical manifestation of intracranial hypertension, and the relation of the tumor to the superior sagittal sinus and the falciform process the authors gained important information on changes of the brain ventricles in patients with tumors of parasagittal location.

[Phasic nature of intracranial hypertension in patients with parasagittal meningiomas]. / Faznost' vnutricherepnoi gipertenzii u bol'nykh s parasagittal'nymi meningiomami.

Complex quantitative determination of the relationship of the cerebrospinal system viscoelastic properties and the CSF dynamics in the brain contributed to identification of the phase character of intracranial hypertension in patients with parasagittal meningiomas and to the disclosure of compensatory mechanisms which come into action during the development of intracranial hypertension. Pathophysiological analysis of the functional condition of these compensatory mechanisms may be of essential importance in deciding on the optimum terms for the surgical treatment of patients with parasagittal meningiomas and for prognosticating the results of neurosurgical operations.