[Development of postgraduate education for doctors-internists].

Medical progress and to optimize the management of health is largely dependent upon the effectiveness of the modernization of education and science. The primary objective in this regard is the creation of a new management model clinics. International experience has confirmed the effectiveness of the cluster approach. Another important development is the transition to single-channel financing, improving the monitoring of the quality of medical care. To solve these problems it is necessary to develop a model management model clinic based on modern technologies of strategic management and information technology, optimizations of economic activity, social monitoring system of public satisfaction with the quality of medical care.

[Stage-by-stage medical rehabilitation of patients with stroke].

Actuality of medical rehabilitation of patients that carried a stroke is important (see text)--by a social problem. The special value a medical rehabilitation has after the consequences of stroke in connection with large (see text) of such patients. Proceeding in a capacity for patients that survived after a stroke, problematic. For determination of volume of rehabilitation interventions it is necessary to take into account weight of motion of stroke, his variants (ischemic, hemorragic) and stages (terms) of development.

[Teaching curriculum about the nervous system infections for general practitioners of family practice].

Poor health-care system of Ukraine was the impetus for radical reform of the industry through the introduction of family medicine as a primary care for population. This led to the necessity for rapid training of the specialists and the development of special training programs in medical universities. Teachers have a problem to form a work model of general practitioners in severe diagnostic cases, which is especially important in the case of septic lesions of the nervous system.

[The adaptive potentials of those who worked in the cleanup of the aftermath of the accident at the Chernobyl Atomic Electric Power Station under the influence of different treatment methods]. / Adaptatsiini mozhlyvosti u likvidatoriv naslidkiv avariï na ChAES pid vplyvom riznykh metodiv likuvannia.

A comprehensive evaluation was done in 162 patients-liquidators of the Chernobyl accident. Of these, 80 percent were diagnosed as having stage I and II dyscirculatory encephalopathy (DE), 20 percent were in stage III. It is shown that DE progression is caused by great strain on and breakdown of autoregulatory mechanisms of different biological systems (vascular, central nervous and vegetative, hormonal), and of central regulatory mechanisms as well. Under certain conditions there may occur their breakdown, with syncopal states, crises, and even insults developing in its wake. Treatment and rehabilitation of DE liquidators with pyracetam, vinpocetine, cerebrolysine with magne B6, and phytosorbents (spirulina, quercitrol, and vitapectine) lead to reconditioning of central and autoregulatory compensatory-and-adaptive mechanisms, long-lasting remission, provide complication prophylaxis and promote work activity.

[The catamnesis of patients with cerebral circulatory disorders in stenosing and occlusal lesions of the extracranial branches of the internal carotid artery who were treated surgically and who were not]. / Katamnez khvorykh z porushenniam mozkovoho krovoobihu pry stenozuiuchykh ta okliuziinykh urazhenniakh ekstrakranial'nykh viddiliv vnutrishn'oï sonnoï arteriï, iaki likuvalys' khirurhichno i neoperovanykh khvorykh.

A catamnestic follow-up was carried out of 70 patients presenting with recurrent cerebral circulatory disorders (CCD). Of these, 35 were patients operated on, with other 35 on drug therapy only. A comparative characterization of catamnesis of patients with stenosis of intracranial portions of internal carotid artery (ICA), operated- and non-operated on, showed that recurrent ischemic insult occurs three times as frequently among the nonoperated--on patients than it does among those operated on, with recurrent transitory CCD being seen only in the patients nonoperated on. Surgical removal of stenosing lesion of ISA prevents the recurrent CCD in 60% of cases. Drug therapy of CCD in stenosing lesions of extracranial portions of ICA is not much help, for no medical agent is capable of eliminating the gross deformation of vessels.

[Clinico-structural changes in the brain in cerebrovascular insufficiency]. / Kliniko-strukturni zminy holovnoho mozku pry tserebrovaskuliarnii nedostatnosti.

Overall seventy patients with chronic hypertensive encephalopathy and acute cerebral circulatory disorders were examined, their age ranging between 35 to 75 years, by ACT, MRT, USG. MRT was found out to be the most objective method for identifying structural changes in the brain in cerebrovascular disorders. The main signs of MR-tomography are vascular changes presenting as lacunar infarctions with or without perifocal area of edema, hydrocephalus, brain swelling, intracranial hypertension, poor differentiation of gray and white substances of the brain, with hygromas being readily identifiable. Lacunar infarctions, periventricular edema, dilatation of the ventricular system are regarded as equivalent of clinical signs of chronic hypertensive encephalopathy.

[Specific strategies in the treatment of young and middle-age patients with spontaneous intracerebral hemorrhage]. / Osoblyvosti taktyty likuvannia khvorykh molodoho ta seredn'oho viku iz spontannym vnutrishn'omozkovym krovovylyvom.

The paper is based on the analysis of 235 young and middle-age patients with non-traumatic cerebral hemorrhage. Tactics of treatment is determined for each group depending on bleeding localization in accordance with World Health Organization's classification (1981). Operative treatment is recommended for lateral site of hematomas of 25 cm3 and more signs of media structures dislocation of 5 mm and more. With the development of hypertension-hydrocephal syndrome surgical intervention is directed at its elimination and where possible at hematoma's ablation. The amount of operative interventions is limited in case of medial and mixed variants of hemorrhages especially when bleedings affect mesencephal structures. In conditions of a neurosurgical clinic a pharmacotherapy is used as an independent one, as a preparation for surgical treatment as well as during operation and in postoperative period.

[Clinical aspects and diagnostic characteristics of nontraumatic intracerebral hemorrhage]. / Klinika ta osoblyvosti diahnostyky netravmatychnoho vnutrishn'omozkovoho krovovylyvu.

The results of treatment of 235 young and middle age patients with nontraumatic intracerebral haemorrhage were analyzed. Diagnosis was verified with the help of computer tomography, magnetic-resonance tomography, angiography and basing on operational and autopsy data as well. Three main symptoms, reflecting the dislocational changes dynamics, were assigned.

[The characteristics of cerebrovascular disorders in persons exposed to the effect of ionizing radiation as a result of the accident at the Chernobyl Atomic Electric Power Station]. / Obsoblyvosti tserebrovaskuliarnykh porushen' u osib, ialki zaznaly vplyvu ionizuiuchoho vyprominiuvannia vnaslidok avariï na ChAES.

Small doses of radioactive irradiation were found to be associated with damage to all levels of the nervous system, as evidenced by cliniconeurological investigations. But regulatory functions and vascular system get it most of all. Commonly seen in the sample was vegetovascular dystonia, also revealed were a varying degree discirculatory encephalopathy, acute disturbances in cerebral circulation, dyscirculatory myelopathy. Vascular abnormalities may develop at any age but in young adulthood they tend to occur more frequently. Clinical manifestations of vegetovascular dystonia were characterized by profound mixed type vegetative crises. Even if treated, vegetovascular dystonia tends to acquire remittent-and-progredient course leading to decompensation very soon. Strokes run atypical course: hemorrhages occur more often than not; circulatory disorders come about against the background of normal arterial blood pressure or insignificant its fluctuations. Hemorrhage may run gradually progressing course, which fact makes their diagnosis very difficult even with modern techniques being involved in relevent studies. It is not infrequently that carotid angiography does not find any structural-and-morphologic changes in the main vessels. A separate nozologic form, viz. that of discirculatory encephalopacy due to radiative irradiation, is suggested, as an entity worth introducing into the medical nomenclature.

[The clinical characteristics of a cerebral ischemic stroke with a tumor-like course]. / Klinicheksie osobennosti ishemicheskogo insul'ta mozga s opukholepodobnym techeniem.

A complex examination (clinical picture, EEG, REG, EchoEG, CT, angiography) of 27 patients with ischemic stroke showing a tumour-like course allowed to single out three variations of stroke course: with a stormy development of the disease due to the hypertensive syndrome; with a remittent course; with epileptic seizures and absence in the postseizure period. The character and frequency of the above variants of the onset and further clinical course of cerebrovascular insufficiency will favour early diagnosis and efficient treatment of the disease.

[Emergency care at the prehospital and early hospital stages for patients with acute cerebrovascular diseases]. / Neotlozhnaia pomoshch' na dogospital'nom i rannem gospital'nom étapakh bol'nym s ostrymi tserebrovaskuliarnymi zabolevaniiami.

Many-year observations, literary data were analyzed to work out indications for hospitalization and methods of transportation of patients with acute cerebrovascular disease to intensive care departments, neurosurgical or neurological department. The problem of non-differentiated and differentiated treatment at the prehospital and early hospital stage is discussed.

[The treatment of hypertension patients with neurological disorders]. / O lechenii bol'nykh gipertonicheskoi bolezn'iu s nevrologicheskimi narusheniiami.

The authors describe the efficiency of complex treatment of patients suffering of hypertensive disease with phenomena of dyscirculatory encephalopathy. It is concluded that cavinton and pyracetam depending on the type of central hemodynamics and type of vegetative nervous activity proved effective.