[Automated system of radiation monitoring in Moscow region].

The authors consider one trend in activities of "Radon"--Center of Radiation and Ecologic Control. The article covers foundation reasons and longstanding function results of operative radiation monitoring system for large industrial city. Features of construction and functioning of the system are shown. Devices for operative radiation monitoring are subjected to comparative analysis. Prospective trends of the system development are described.

[Local cerebral blood flow, cortical impedance, cerebral intravascular kinin production during forebrain ischemia and reperfusion in rats]. / Lokal'nyi mozgovoi krovotok, kortikal'nyi impedans, tserebral'noe vnutrisosudistoe kininoobrazovanie pri perednemozgovoi ishemii i reperfuzii u krys.

In the rat model of forebrain ischemia with subsequent reperfusion, an obvious formation of intravascular kinin (IVKF) occurred. The IVKF preceded and coincided in time with the maximum hyperemia and a vasogenic oedema. Local cerebral blood flow (LCBF) increased up to about 187%, at that. In three groups of experimental rats, a correlation was revealed among the ischemia obviousness, IVKF, and development of the brain oedema.

[Oxygen imbalance, blood flow and impedance of the brain in ischemia and reperfusion in rats]. / Narushenie kislorodnogo balansa, krovotok i impedans golovnogo mozga pri ego ishemii i reperfuzii u krys.

In anesthetised rats, during the ischemic period a brain swelling, a decrease in oxygen tension and an increase in the blood doxygenation velocity occurred. In reperfusion, even more obvious disorders of the oxygen balance were revealed suggesting a disorder in the mitochondrial function.

[The diagnosis and treatment of chronic cerebrovascular insufficiency in atherosclerotic stenosis or occlusion of the carotid artery]. / Diagnostika i lechenie khronicheskoi tserebrovaskuliarnoi nedostatochnosti pri ateroskleroticheskom stenoze ili okkliuzii sonnoi arterii.

The methods of diagnosis and treatment of chronic cerebro-vascular insufficiency in atherosclerotic stenosis or occlusion of the carotid artery are described. Ambulatory examinations were performed in 62000 patients. Clinical and psychological tests were used in examining 123 patients with ischemic brain disease. The present-day diagnostic methods were used in treatment of 1100 patients (clinical tests, CT, MRT, EEG, Ag, TCD). Operations were performed on 546 patients (carotid endarterectomy, extracranial-intracranial bypass). Results of operations for making the extra-intracranial microvascular bypasses for revascularization of the ischemic hemisphere were estimated as positive. Direct correlations were found between the structural-functional state of the CNS and the degree of neurological deficiency. The 1-13 years follow-up allows a conclusion to be made that surgical treatment is more perspective than conservative methods.

[The choice of the methods for the surgical treatment of patients with cerebral arteriovenous malformations]. / Vybor metodov khirurgicheskogo lecheniia bol'nykh s arteriovenoznymi mal'formatsiiami golovnogo mozga.

The paper analyzes the outcomes of surgical treatment made in 431 patients in 1971-1994. Multimodality treatment for this abnormality was used, which reduced postoperative mortality.

[The intravascular formation of kinins in the brain studied as a new approach to the problem of the re-circulatory complications in the surgical treatment of cerebral ischemia]. / Izuchenie vnutrisosudistogo obrazovaniia kininov v golovnom mozge kak novyi podkhod k probleme retsirkuliatornykh oslozhnenii pri khirurgicheskom lechenii tserebral'noi ischemii.

The improvement of blood supply in the ischemic brain (post-ischemic cerebral reperfusion), which results from surgical treatment, has been shown to improve the neurological status only in the patients who had no lower baseline levels of kininogens (the production of free kinins) in cerebral circulation. Poor surgical outcomes were noted in the cases wherein there was preoperative activated kinin production when blood passed through the brain. Postischemic brain reperfusion was concurrent with kinin production in the cerebral vascular bed in all examinees, but in patients with postoperative complications this process is more active and involves the two kinin-forming systems tissue and plasma ones. It is hypothesized that in the latter case kinins convert from the compensatory to the pathogenetic factor of secondary circulatory disorders. The correlations found may be used to substantiate the use of antikinin therapy and to develop a biochemical test that predicts possible complications after surgical treatment of cerebral circulatory ischemia.

[Primitive trigeminal artery combined with arteriovenous malformation of the brain]. / Primitivnaia troinichnaia arteriia, sochetaiushchaiasia s arteriovenoznym porokom razvitiia golovnogo mozga.

Analysis of the brain circulation and consequences of the intravascular surgery in a woman of 22 with a combined pathology--a primitive trifacial artery with an arteriovenous brain malformation--are presented. The arteriovenous malformation was cured surgically with the use of polystyrene emboli some of which penetrated through the primitive trifacial artery into the branches of carotis interna. The possibilities of the above combinations should be taken into consideration when the method of the intra-vascular surgery is to be chosen.

[Proton stereotaxic therapy of epilepsy due to cerebral arteriovenous aneurysms]. / Protonnaia stereotaksicheskaia terapiia épilepsii pri arteriovenoznykh anevrizmakh golovnogo mozga.

The authors estimated the influence of proton-beam stereotaxic therapy on a course of epileptic fits in cerebral arteriovenous aneurysms (AVA). A stable disappearance of epileptic fits was noted in 16 of 29 patients (56%), in 12 of them (41%) positive angiography results were noted. The calculated D and V fields of irradiation for 16 patients without fits and for 13 patients with epileptic fits after proton-beam stereotaxic therapy have shown that with D being the same, the effect depends upon a fraction of an AVA irradiated area.

[Arteriovenous shunting of cerebral blood flow in basal meningo- cerebral developmental anomalies and paraganglioma of the glomus jugulare]. / Arteriovenoznoe shuntirovanie mozgovogo krovotoka pri bazal'nom obolochenno-mozgovom poroke razvitiia i paragangliome iaremnogo glomusa.

The authors describe a case of angiographically verified arteriovenous shunting of the cerebral blood flow coupled with basal ++meningo-cerebral developmental abnormality and paraganglioma of the glomus jugulare in a 52-year-old patient. Such a unique combination made it possible to suggest the existence of potential mechanisms of blood flow shunting either via tumorous vessels or vessels (arteriovenous shunts) of the basal ++meningo-cerebral developmental abnormality. In the latter case, the shunts were likely to occur latently while the clinical manifestations of the disease might be related to the tumor growth, impairment of the venous outflow and disclosure of arteriovenous shunts.

[The rheo-encephalogram during intense reduction of pulse blood-filling of extra- and intracranial tissues]. / Reoéntsefalogramma pri intensivnom umen'shenii pul'sovogo krovenapolneniia vne- ili vnutricherepnykh tkanei.

The changes in the rheoencephalography (REG) values on the side of the occlusion was studied in 18 patients with arterial aneurysms during intravascular manipulations for balloon occlusion of the internal or external carotid artery. Statistically significant changes of the REG amplitude occurred in occlusion of the external carotid artery. Occlusion of the internal carotid artery failed to produce statistically significant changes of the REG amplitude.

[Features of the surgical treatment and immediate postoperative period of patients in the acute period of rupture of arterial aneurysms of the cerebral vessels]. / Osobennosti khirurgicheskogo lechniia i blizhaishego posleoperatsionnogo perioda u bol'nykh v ostrom periode razryva arterial'nykh anevrizm mozgovykh sosudov.

The authors analyse the course of the immediate postoperative period in 27 patients with ruptured arterial aneurysms of the cerebral vessels. The dynamics of the local cerebral blood flow and electric resistance of the brain matter were examined for a comprehensive study of changes in cerebral circulation and metabolism. Intracranial pressure (ventricular and subdural) and mechanical resistance of the brain matter were measured with the M-34 mingograph. Such combination of the examination methods and the findings of neurological examination made it possible to study over time the pathological processes which are interconnected (circulation-metabolism-edema and swelling of the brain) and determine the course of the postoperative period. A dependence between the preoperative condition of patients and the course of the immediate postoperative period was revealed, adequate methods for correction of the pathological reactions are suggested, and the specific features of a complex clinico-physiological control in this category of patients and the informativeness of the different methods of examination are discussed.

[1st attempt at dilating spastic cerebral arteries in the acute stage of rupture of arterial aneurysms]. / Nachal'nyi opyt dilatatsii spazmirovannykh mozgovykh sosudov v ostrom periode razryva arterial'nykh anevrizm.

The article deals with the substantiation, techniques, and possibilities of treating long-term spasm of the cerebral vessels in patients with ruptured arterial aneurysms by means of an intravascular intervention, dilatation of the spastic vessels with a balloon catheter. Thirty-three large cerebral vessels (internal carotid arteries, the basilar artery, and their branches) were dilated in 13 patients. Vasodilation could not be accomplished in only one patient in the group discussed. The increase in the vascular lumen proved to be stable, and the functional state of the brain in patients subjected to surgical treatment of spasm of the cerebral vessels improved. The authors discuss the indications for and the performance of the suggested intervention, the time of its performance, the boundaries of vasodilatation, and possible mechanisms of circulation improvement in the brain stem. The duration of the effect of dilatation of the spastic cerebral vessels is, according to the authors, the most complex problem.

[Functional significance of the internal carotid arteries and collateral circulation in cerebral aneurysm surgery]. / Funktsional'noe znachenie vnutrennikh sonnykh arterii i kollateral'noe krovoobrashchenie v khirurgii anevrizm sosudov golovnogo mozga.

The functional significance of the internal carotid artery was appraised in 18 patients with arterial, in 8 with arteriovenous aneurysms and in one patient with atherosclerosis of the cerebral vessels. The appraisal was based on changes in the intracarotid pressure and regional cerebral blood flow (quantitative criteria) in temporary occlusion of the internal carotid artery with a double-lumen balloon catheter and on the change in the patients' clinical condition during temporary or stationary arrest of blood flow through the internal carotid artery that is studied. In large arteriovenous aneurysms, the collateral circulation ensures adequate blood supply to the brain tissue on the side of temporary occlusion of the internal carotid artery. The functional importance of the internal carotid artery in patients with arterial aneurysms points to the possibility of reconstructive operations in aneurysms of the internal carotid artery which are inaccessible for direct intervention. However, it is expedient in every case to make sure that the operation is safe by preoperative appraisal by means of the suggested method.

[Clinical picture and complex treatment of septic thromboses of the cavernous sinuses]. / Nekotorye voprosy kliniki i kompleksnogo lecheniia septicheskikh trombozov kavernoznykh sinusov.

Under analysis are etiology, clinical picture and diagnosis of a septic thrombosis of cavernous sinuses in 28 patients. The authors have shown the interrelationship between local manifestations of the disease, injuries of the brain and its sheaths and septic complications (abscessing pneumonia as the most severe of them). A scheme of the complex treatment of patients with thrombosis of the cavernous sinus is proposed. The leading role in this treatment is played by intracarotid infusion of antibiotics in combination with anticoagulant drugs, vasodilatatory agents and novocaine as well as the therapy of septic complications (abscesses of the face and hairy part of the head, meningoencephalitis, pneumonia).

[Certain clinico-anatomic features of large and giant arterial aneurysms of cerebral vessels]. / Nekotorye kliniko-anatomicheskie osobennosti krupnykh i gigantskikh arterial'nykh anevrizm mozgovykh sosudov.

On the basis of examining 72 patients 14 of whom later died it has been concluded that the most substantial differences of large and giant aneurysms of cerebral arteries from small ones consist in development of focal neurological symptoms and intracranial hypertension: this is due to both compression of the brain structures and disturbance of the cerebral circulation caused by aneurysms more than 2 cm long. The intracranial hypertension is the most frequent in aneurysms over 3 cm long, especially, if those aneurysms are localized in the vicinity of cerebral liquor ducts. Patients with arterial aneurysms exceeding 2 cm develop hemorrhagic complications in 2/3 of the cases. While using modern treatment methods (stereotaxic and intravascular) one should take into account the peculiarities of the structure of large and giant aneurysms in the brain.