[Modern problems of stroke at different hospitalization stages based on the data of the Regional Vascular Center of Tyumen]. / Sovremennye problemy tserebral'nogo insul'ta na étapakh gospitalizatsii, po dannym Regional'nogo sosudistogo tsentra Tiumeni.

AIM: To analyze clinical and organizational aspects of stroke patients care and factors affecting the outcomes of the disease at the prehospital and inpatient stages. MATERIAL AND METHODS: The medical documentation of patients with acute vascular lesions of the brain who were admitted and were subsequently treated at the Regional Vascular Center in Tyumen in 2016-2018 was studied retrospectively. At the first stage, factors affecting the delay in admission of patients (n=173) to the hospital were identified. At the second stage, the frequency and nature of discrepancies in diagnoses were determined, as well as the main factors affecting mortality at each stage of hospitalization of patients. For this purpose, 1330 accompanying documents and 508 case histories of patients with transient ischemic attacks and cerebral infarction were studied. RESULTS AND CONCLUSION: The main factor affecting the transfer of patients to the hospital outside the 'therapeutic window' was living alone (58.8%, p=0.01). There was a significant number of discrepancies in the diagnoses of the referring institution (73.7% in out-patient clinics and 61.9% in other referring hospitals (p<0.001)), the emergency department and the specialized vascular department of the inpatient department which were significantly correlated with the mortality rate. In cases when all three diagnoses differed, the probability of a fatal outcome increased from 18.9 to 80.0% (p<0.001).

[Use of mitoxantrone in the treatment of multiple sclerosis].

Despite the significant success achieved in the treatment of multiple sclerosis (MS) that allows to control the disease course, neurologists have to use immunosupressors in cases of progressive course or ineffectiveness of the first-choice drugs (beta-interferons and glatimer acetate). Currently, mitoxantron is one of the widely used immunosupressors. Thirty patients with MS with relapsing and secondary-progressive MS receiving mitoxantron were studied in the Tyumen's MS center. Neurological status, frequency of exacerbations, progression index were evaluated. Brain MRI was conducted. Safety and tolerability of mitoxantron were assessed as well. Duration of the study was on average 39 months. The significant reduction of pathological process activity reflected in stopping exacerbations in relapsing MS was found. The rate of disease progression was decreased significantly in secondary-progressive MS. The first results of this study revealed that mitoxantron was well tolerated in the monotherapy and in the combination with immunomodulators. Because of remote risks of side-effects, all patients treated with mitoxantron should be examined not only during the treatment but in the following years.

[Restoration of voice function in patients without larynx and pharyx: myth or reality?].

The article presents an original technique of voice restoration in patients who have undergone laryngopharyngectomy with resection of esophageal cervical part; analyses mechanism of phonation. Four cases of prosthetic reconstruction are reported. The necessity and feasibility of voice rehabilitation in patients with this severe condition are validated.

[Epidemiology of multiple sclerosis in Tiumen' region].

Prevalence of multiple sclerosis (MS) was evaluated in the pilot study of 731 patients living in Tyumen city and a southern part of Tyumen region as well as in Khanty-Mansi (KMAO) and Yamal-Nenets (YNAO) autonomic okrugs. An index of MS prevalence was 22,4 per 100,000 in Tyumen region as a whole. This index was higher--29.1 per 100 000 - in the southern part. In KMAO and YNAO, the MS prevalence was 14,3 and 27,8 respectively. Women prevailed among patients in all the regions, their number being twice higher (461 and 270). However, if in the southern part and in KMAO this ratio was approximately equal, in YNAO percentage of men was significantly higher. It should be noted that these data need further study. We revealed that using of current diagnostic criteria may often lead to misunderstanding of diagnosis of "definite" MS. Essential difference in MS prevalence in different regions may be explained by ethnical stratification. In particular, there are many newly migrated people in the okrugs and MS occurs more often in that group. At the same time, there is no any information on the prevalence of "definite" MS among the native-born population of KMAO and YNAO.

[ATPase activity and erythrocyte levels of potassium, sodium, calcium and cholesterol and its fractions and esters in patients in the acute period of cerebral stroke]. / Aktivnost' ATFaz, soderzhanie kaliia, natriia, kal'tsiia, kholesterina, ego fraktsii i éfirov v éritrotsitakh u bol'nykh v ostrom periode tserebral'nogo insul'ta.

Ca2+, Mg2+, K+, Na+ ATPase activities, and the changes in K, Na, Ca, cholesterol, its fractions and esters contents in the red blood cells of 95 patients with acute cerebral stroke were studied on day 1-3, 5-7, 19-21. Statistically significant differences were found in the enzyme activities, the levels of K, Na, Ca, cholesterol and its fractions and esters in the red blood cells of patients vs. healthy donors. These features were dependent on the nature of the stroke: reversible--irreversible, ischemic--hemorrhagic.