[Stroke risk stratification in elderly patients with comorbid sarcopenia and atherosclerosis]. / Stratifikatsii riska ostrykh narushenii mozgovogo krovoobrashcheniya pri sochetanii ateroskleroza i sarkopenii u patsientov pozhilogo vozrasta.

OBJECTIVE: The study was to investigate the features of carotid arteries atherosclerosis as the leading risk factor for atherothrombotic stroke in elderly patients depending on the presence of sarcopenia. MATERIAL AND METHODS: 2 groups of patients above the working age were examined: 110 patients with normal muscle mass and 24 suffering sarcopenia. Ultrasound examination of carotid and vertebral arteries extracranial segments was performed with an assessment of atherosclerotic changes severity, atherosclerotic plaques instability, 10-year risk of stroke (according to Framingham risk score) and a 10-year risk of fatal cardiovascular disease (SCORE risk scale). RESULTS: 10-year risk of fatal cardiovascular disease was 3 [2; 5] points for patients without sarcopenia, 3 [2; 3] points for patients with sarcopenia (p=0.81). The 10-year risk of stroke was 16 [12; 18] for patients without sarcopenia, 18 [15; 22] points for patients with sarcopenia (p=0.1). Due to the ultrasound examination data the incidence of carotid arteries atherosclerotic lesions in patients without sarcopenia was 50 (46.3%), in patients with sarcopenia - 18 (75.0%) (p=0.01). Statistically significant (p<0.05) increase in the atherosclerotic plaques instability signs was revealed in patients suffering sarcopenia compared to those without it: heterogeneous echotexture - 66.7% cases versus 38.2% (p=0.01), presence of hypoechoic masses - 41.7% patients vs 12.7% (p=0.02). CONCLUSION: It is important to take into account not only traditional risk factors in the overall assessment of cardiovascular risk as well as therapeutic and preventive measures planning in elderly patients, but also pay attention to body composition since modern diagnostic systems may be not sensitive enough to identify high-risk patients with comorbid atherosclerosis and sarcopenia.

[Paradoxical air embolism of intracerebral arteries as a complication of tooth extraction]. / Paradoksal'naya vozdushnaya emboliya vnutrimozgovykh arterii kak oslozhnenie ekstraktsii zuba.

The article describes the rare clinical case, demonstrating sudden onset of neurological manifestations (seizures and consequent formation of ischemic stroke foci) in a 29 year-old female patient during tooth extraction (right lower third molar) using the high-speed dental drill. Air injection through damaged tissues caused subcutaneous emphysema in the buccal area that caused air embolism. Presence of asymptomatic congenital heart defect in the patient (atrial septal defect) allowed the bubbles of air to move paradoxically from right to left with consequent embolization of small cerebral arteries. Treatment in specialized department was successful and had beneficial effect on patient's condition.

[Surgical treatment results of metastatic spine disease with using minimally invasive technologies, including 3D video endoscopic technologies]. / Rezul'taty khirurgicheskogo lecheniya metastaticheskikh porazhenii pozvonochnika s primeneniem maloinvazivnykh metodov lecheniya, v tom chisle 3D-videoendoskopicheskikh tekhnologii.

THE AIM OF THE STUDY: Was to evaluate the results of surgical treatment of patients with metastatic lesions of the spine using 3-D video endoscopic technologies. MATERIAL AND METHODS: We analysed the results of surgical treatment of 33 patients with metastatic lesions of the thoracic spine using a 3D video-assisted thoracoscopic intervention that was performed from November 2017 to December 2019. When examining patients, the following were used: X-ray of the spine, spiral computed tomography (CT), magnetic resonance imaging (MRI), as well as the SINS, Bilsky, Karnovsky, Tokuhashi, Frankel, SF-36 and VAS scales. RESULTS: The actual life expectancy of the patients completely coincided with the predicted one according to the Tokuhashi scale. Regression of neurological disorders in the early postoperative period (before discharge from the hospital) was observed in 6% of patients (complete in 3%, partial in 3%). When evaluating the results of treatment 12 months after surgery, regression of neurological symptoms was observed in 19% of patients. At the same time, complete regression of neurological disorders occurred in 10%, partial in 9% of patients. When assessing the quality of life on the SF-36 scale, improvement was observed according to the most of the criteria. Also, in the postoperative period, there was a persistent decrease in the intensity of pain syndrome according to VAS compared with the preoperative level. CONCLUSION: The use of 3-D video endoscopic technologies in the surgical treatment of patients with metastatic lesions of the spine made it possible to improve the quality of life of patients and reduce the number of complications.

[An analysis of the work of vascular service in Smolensk from 2009 to 2014]. / Analiz raboty sosudistoĭ sluzhby Smolenskogo regiona v period s 2009 po 2014 g.

MATERIAL AND METHODS: Report of the regional vascular service center of Smolensk work and work of vascular service of Smolensk region were analyzed. The aim of the study is to analyze work of the vascular service in Smolensk and Smolensk region in 2009-2014. RESULTS AND CONCLUSION: Mortality and morbidity in patients with cardio-vascular diseases in Smolensk Region are higher than in other regions of Russia. Recently a number of patients hospitalized to vascular service centers are increased. Infectious complications (pneumonia, bedsores, pyoderma) take lead place in mortality. Nowadays it's very important to solve the problem with prophylaxis of infectious complications in patients with acute ischemic stroke, also to solve problem with rehabilitation in patients with mild and severe motor disorders and disorders of praxis, gnosis. Continuous training of doctors and nurses in regional vascular service centers is needed. It will increase quality of medical service and improve rehabilitation prognosis in patients with ischemic stroke.

[An expert assessment of medical care quality in patients with acute disturbances of cerebral blood flow at prehospital stage]. / Ékspertnaia otsenka kachestva okazaniia meditsinskoi pomoshchi patsientam s ostrymi narusheniiami mozgovogo krovoobrashcheniia na dogospital'nom étape.

OBJECTIVE: To study the criteria of expert assessment of medical care quality in patients with acute disturbances of cerebral blood flow at prehospital stage in the Smolensk region. MATERIAL AND METHODS: We analyzed the adequacy of medical care to regulation documents of the Russian Federation and worked out several assessment criteria. Based on these criteria, we selected and analyzed 190 ambulance care records over 1 month. RESULTS AND CONCLUSION: The quality of ambulance care was estimated on a three-level scale: satisfactory, satisfactory with minor deficiencies, unsatisfactory. In the Smolensk region, it is characterized by relatively low estimates. These criteria allow to fairly assess the quality of medical care for patients with acute disturbances of cerebral blood flow at prehospital stage.