[The role of evidence-based medicine in the neurorehabilitation: the innovative technologies (a review)].

The present review is focused on the randomized controlled trials and meta-analyses in the field of technological means for neurorehabilitation. The available literature data and the results of original observations provide a basis for distinguishing between the following levels of evidence: instrumental verticalization--2a, robot-assisted mechanotherapy--1a, biological feedback--1a, virtual reality--1a, transcranial magnetic stimulation--1a for central hemiparesis and 1b for speech disturbance and unilateral spatial agnosia, transcranial electrical stimulation--2b, electromyostimulation--1a, telerehabilitation--3. It is concluded that the use of the innovative technologies for the purpose of neurorehabiltation is objectively substantiated. Further investigations are needed to allow their application on an individual basis.

[Experience of percutaneous transhepatic rheolytic thrombectomy using in treatment of postresection portal vein thrombosis].

Vessels resection in case of pancreatic head cancer may be associated with portal vein thrombosis. System AngioJet 9000 (Possis Medical Inc.) for rheolytic thrombectomy is one of endovascular device for treatment of patients with venous thrombosis. Descriptions of 3 cases with rheolytic thrombectomy using are presented in the article. Percutaneous transhepatic approach under ultrasound control was used for visualization of portal vein branches. Stent-grafts were implanted in 2 of 3 cases after thrombectomy in zone of portal vein thrombosis. Bleeding from liver puncture site was observed in 1 case in early postoperative period. There was not recurrent thrombosis in long-term postoperative period (31 months after surgery maximally). The authors consider that use of several endovascular techniques such as rheolytic thrombectomy with stenting or without it provides satisfactory clinical results in treatment of patients with postoperative portal vein thrombosis.

[Modern methods of rehabilitation for poststroke patients]. / Sovremennye metody reabilitatsii postinsul'tnykh bol'nykh.

The article reviews the problem of complex post stroke rehabilitation. Special attention is drawn to neurorehabilitation aspect of patient's state, restorative treatment in the acute stage of stroke, peculiarities of working up individualized rehabilitation programs, innovations and medicament support of rehabilitation process.

[Methodological and organizational bases for the early rehabilitation of the patients under conditions of a multidisciplinary clinic].

The Federal Medical and Rehabilitation Center of the Russian Health Ministry Health is a unique therapeutic and prophylactic setting. Its unique character is attributable to the fact that it incorporates specialized clinical departments that provide high-tech medical care and the Center for Restorative Medicine and Rehabilitation. Collaboration of these units permits to initiate rehabilitative measures from the very first day of the patient's stay in the hospital with due regard for the nosological form of his (her) disease. The activities of the Center for Restorative Medicine and Rehabilitation are based on the application of up-to-date remediation technologies that ensure the long-term rehabilitative effect and allow the duration of hospital stay to be decreased. During many years of practical work, the Centre has developed the proper organizational structure and gained a vast experience of comprehensive early rehabilitation after the most common diseases that was summarized by its specialists in numerous publications and theses and was many times reported at various scientific forums in this country and abroad.

[Comprehensive programs and evaluation of the efficacy of early postoperative rehabilitation in the patients following total endoprosthetics of the lower extremity joints].

A total of 562 patients completed the course of rehabilitative treatment in the early postoperative period after the total replacement of hip joints in the lower extremities. Early mobilization (the first walking experience within 3-4 hours after surgery) is not only possible, but is also associated with the lower levels of pain and anxiety. The analysis of X-ray images of the operated joints 12 months after the replacement revealed no signs of mechanical loosening of the prosthetic components which gives evidence of the safety of early postoperative walking.

[The development of physical education as a basic instrument of rehabilitative treatment, remedial medicine, and goal-oriented health promotion for the benefit of man].

This paper presents a brief description of the development of physical therapy as a basic technology for medical rehabilitation and the current state of research activities in this field at the Federal Therapeutic and Rehabilitative Centre. The importance of targeted re-equipment of health centres, departments of medical rehabilitation and remedial medicine is emphasized for the wider application of novel health-promoting technologies and optimization of control over health improvement procedures through increasing and mobilizing the functional reserves of the human body.

[Physical education and training in the system of purpose-oriented health promotion at the stage of medical rehabilitation].

The present article concerns organization of the health promotion system and its practical implementation with a view to making healthier the population of Russia in general.

[Minimally invasive methods for the treatment of the recurrent varicosis].

The experience of 193 cases of recurrent variceal disease (RVD) was summarized. Major reasons of recurrences after surgery were analyzed. Traditional and miniinvasive RVD treatment approaches are listed and its efficacy was thoroughly analyzed. Thus, endovasal laser coagulation and phleboscleroobliteration of insufficient communicant veins were effective in 85% and 65% of RVD, respectively. Possibilities of cryophleboextraction as well as apparate phlebectomy with transillumination were described.

[Prophylaxis of traumatism and physical methods for the correction of adaptive processes in football players during training exercises].

The present study was focused on etiopathogenetic aspects of injuries and diseases of the locomotor system (LS) in football players. Up-to-date methods for the prevention of LS tissue overstrain during the execution of physical exercises are described. Adequate application of preventive measures allowed biochemical and physiological characteristics of these tissues to be improved. Specifically, the frequency of muscular spasms and pain was reduced to 1.9% compared with 22.8% in the control group.

[New lines of activity of health centres in the Russian Federation].

The first data illustrating work efficiency of health centres in this country are presented. They suggest the necessity to change both the strategy of activities and the patient population. Studies on variability of cardiac rhythms and characteristics of vegetative status in adolescents showed that the equipment used is poorly adapted to the purpose.

[Physical methods for the correction of thermal adaptation and acclimatization of athletes to hot and humid climate].

The objective of the present study was to evaluate the possibility of accelerating adaptation and acclimation of 106 athletes aged from 18 to 34 years to hot and moist conditions by combined treatment including consumption of a special drink and cryomassage including the use of aromatic oils. It was shown that the proposed approach proved highly efficient in that it accelerates acclimatization and adaptation to hot and moist climate.

[Endovascular laser ablation with wavelength 1,560 nm for varicose veins].

In 2002 - 2008 more than 1000 patients with lower limb varicose veins were treated with endovenous laser coagulation (EVLC) of subcutaneous and perforating veins in the Therapeutic Rehabilitation Center. Usually we used laser wavelength between 915 and 980 nm; but recently 1,560-nm laser, which physical properties are quite different, was used for 43 patients, including 49 EVLCs for great (GSV) and lesser (LSV) saphenous veins and 15 EVLCs for perforating veins (PV). Interventional technique was similar to previously used. Postoperative period for 1,560-nm laser ablations was characterized by earlier resolution of mild pain syndrome, more than twice less ecchymosis, and pain absence along the coagulated veins. These resulted of obliteration. in the decrease of postcoagulative period severity, thus enabling patients to ambulate earlier. No complications occurred. Ultrasonic picture of 1,560-nm laser coagulation showed uniform wall thickening, intimal induration and circular narrowing of venous lumen. Histological examination of GSV revealed significant thickening of venous wall due to edema and circular shrinkage, focal necrobiosis and caryolysis. Twenty three patients (who underwent total 35 EVLCs for GSV, LSV and PV) were followed up for 4-6.5 months. In all cases treated veins were completely obliterated; no segments with preserved blood flow and pathological refluxes were revealed. In conclusion, EVLC with wavelength that is actively adsorbed by water is characterized by mild postoperative period and higher efficacy of obliteration.

[Possibility of an emission computer tomography for an estimation cerebral perfusion at patients with carotid stenoses before and after stenting].

THE PURPOSE: To estimate possibilities for studies of cerebral perfusion with brain scintigraphy for revealing and an estimation of features of change brain perfusion at patients with a cardio-cerebral vascular pathology before and after carotid stenting (CAS). MATERIAL AND METHODS: 11 patients with established (after carotid angiography) stenosis of internal carotid artery and coronary artery disease have been studied with SPECT with analogue HMPAO teoxim--Tc99M after intravenous introduction 700 MBk up to and in 5 days and in the remote period after stenting. For analysis of results the program "Neurogam" have been used. Standartized perfusion maps have been created. RESULTS: Before performing CAS various variants of the image cerebral perfusion maps have been obtained: from diffuse insignificant reduction in both hemispheres of a brain up to the regions hypoperfusion, characteristic for ischemic changes. Regions of hypoperfusion on the side opposite to a stenosis or occasion were revealed. SPECT, performed after cas on 5th day or after 2-3 months found increase of general brain perfusion, disappearance of symmetric both asymmetric regions hypoperfusion and reduction of a degree local hypoperfusion on the side of stenting. CONCLUSIONS: Maps of brain perfusion before and after CAS adequately reflect microcirculation of a brain with local changes of perfusion. Use of perfusion parameters gives possibility to estimate changes of brain perfusion before and after CAS in patients with combined carotid and coronary pathology.

[Contemporary approaches to evaluation of psychosomatic status in patients with alimentary tract diseases].

The authors present the results of psychosomatic status evaluation performed in 159 patients with biliary dyskinesia, chronic gastritis, and somatoform disturbances. The examination was done using questionnaires, scales, and computer methods. Computer diagnostic methods were proved to be most effective and allowed for quantitative evaluation of psychosomatic disturbances in patients with gastrointestinal diseases.

[Transillumination phlebectomy in minimally-invasive surgical treatment of varicose disease].

Transillumination phlebectomy with TriVex was used in 72 patients for the surgical treatment of lower extremities varicose veins. Diagnostic protocol, indications and surgical technique are described in detail. Short- and long-term results are assessed. Transillumination guarantees clear visualization of subcutaneous veins. It is an effective method in surgical treatment of varicose disease, permits to decrease number and length of incisions, time of surgery, to achieve good functional and esthetic results.

[Laser obliteration in the treatment of varicose disease of the lower limbs]. / Lazernaia obliteratsiia podkozhnykh ven v lechenii varikoznogo rashireniia ven nizhnikh konechnostei.

Experience of endovenous laser coagulation in the treatment of the varicose disease of the lower extremities is presented. This method was used in 107 patients. Surgical technique of isolated endovenous laser coagulation and combined phlebectomy was described in detail. Morphologic data on laser injury of a venous wall are presented. Short- and long-term results were evaluated with clinical and ultrasonic methods. It is demonstrated that endovenous laser coagulation may be regarded as alternative to traditional saphenectomy. This method decreases surgical trauma, number of complications and hospital stay.

[The use of Ginkor Fort in the program of multimodality rehabilitation treatment of CYI patients with edematous syndrome].

Edematous syndrome is one of the most frequently occurring manifestations of chronic venous insufficiency (CVI). This paper analyzes an experience with conservative treatment of CVI patients with edematous syndrome. A complex of rehabilitation measures was used in addition to therapy by the phleboprotector Ginkor Fort. Based on the study of microcirculatory changes, malleolar volume, the thickness of subcutaneous fat as well as on subjective sensations and the quality of life in 117 patients with the edematous forms of CVI the authors have demonstrated the high efficacy of combined pharmacotherapy by Ginkor Fort and rehabilitation treatment in the given patient group.