[Characteristics of motility function of the esophagus in patients with aphagia].

In article is shown the results of investigation of motility function of esophagus in 18 patients with pharyngoesophageal obstruction. 16 patients were operated. The essence of method was in simultaneous registration of UES intracavitary pressure and impedance. We discovered that all patients have both not opening of for the swallow and disturbances of sphincteral function of LES and contractive activity of thoracic esophagus. Dynamic of this parameters in 7 operated patients was monitored. Obtained data were analyzed according to clinical results of surgery.

[Diagnostics and surgical treatment of pharyngoesophageal impassability].

Data of 29 patients with pharyngoesophageal impassability are analyzed. The condition was a result of a stroke in 89,6% of patients. Radiographic contrast pharyngo- and esophagoscopy (n=29), video X-ray of the swallowing act (n=20), esophagogastroduodenoscopy (n=29) and pharyngoesophagomanometry (n=18) were performed as diagnostic measures. The basal tone of the upper esophageal sphincter was high in 10 patients and decreased in 8. 25 patients were operated on: Chodosh cricopharyngeal myotomy was performed in 7 patients, 18 standed the pharyngoesophageal plasty with inferior constrictor muscle of pharynx's fibers shift after the original method. Follow-up was carried out from 1 month to 2 years. Superb and good results were achieved in 42,7% patients after cricopharyngeal myotomy and in 77,8% patients after the pharyngoesophageal plasty.

[Respiratory failure in disseminated sclerosis]. / Dykhatel'naia nedostatochnost' pri rasseiannom skleroze.

The development and patterns of respiratory failure (RF) are analyzed in 9 patients with disseminated sclerosis (DS). Forced ventilation of the lungs was carried out with consideration for main location of the process. Relationship between patterns of respiratory disorders and neuroanatomy of respiratory regulation is discussed. Involvement of the corticospinal routes is paralleled by dissociation during functional pulmonary tests: spontaneous volumes are less than controlled inspirations. The most severe symptom complexes were observed in RF of predominantly bulbar localization: respiratory anarchy, blocking of airways caused by impaired swallowing, impaired mechanism of coughing reflex, loss of spontaneous respiration, sometimes apnea during sleeping. Involvement of the respiratory nuclei of medullary respiratory center and airways and of the corticonuclear routes of caudal cranial nerves causes the development of a triad of symptoms: glossopharyngolaryngeal paralysis, dysfunction of respiratory nuclei of medulla oblongata, and decreased sensitivity of respiratory center to CO2. Aspiration complications caused by dysphagia are characteristic of bulbar DS. Respiratory function in 5 patients without clinical picture of RF are specially discussed. The authors emphasize unfavorable prognostic significance of signs of extracorporeal obstruction indicating the probability of RF long before its manifestation. Special attention is paid to early diagnosis of symptoms of coming RF when evaluating the status of patients with DS during treatment. Timely use of respiratory resuscitation methods reduces the mortality and ensures a good chance for remissions with recovery of respiratory function, which are characteristic of RF.

[Videofluoroscopy study of swallowing in neurogenic dysphagia]. / Videofliuoroskopicheskoe issledovanie glotaniia pri neirogennoi disfagii.

Videofluoroscopy (VFS) was for the first time used for examining swallowing in 49 patients with nervous diseases. Disturbances in each phase of swallowing act are analyzed with evaluation of the time parameters and defects, causes of aspiration in neurogenic dysphagia are discussed, and cricopharyngeal insufficiency is described. Neurogenic dysphagia is characterized by a combination of disorders which determine the degree of dysphagia. The most severe swallowing disorders were observed in patients with multiple foci in the brain stem and in diphtheritic polyneuropathies. The authors conclude that VFS is the optimal method for the diagnosis of neurogenic dysphagia.

[The treatment of demyelinating polyneuropathies of different origins with small doses of immunoglobulin G]. / Lechenie demieliniziruiushchikh polineiropatii razlichnogo geneza malymi dozami immunoglobulina G.

Application of small doses of IgG-Sandoglobulin (0.16 to 0.98 g per kg of body weight) was quite effective in 2 patients with Guillain-Barré syndrome and in 2 cases of diphtheritic polyneuropathy. These patients had a severe form of the disease with disorders of essential functions. An international course of the disease in one case of IgG treatment was observed. Meanwhile preparation was uneffective in 2 patients with chronic inflammatory demyelinating polyneuropathy caused by lymphoproliferative process. It is worth while to accumulate experience to define optimal doses of the drug.

[Respiratory insufficiency in adults with diphtheric polyneuropathy]. / Dykhatel'naia nedostatochnost' pri difteriinoi polineiropatii u vzroslykh.

Twenty-five adult patients with grave diphtheric polyneuropathy after toxic diphtheria were followed up. Two symptom complexes of neurologic disorders leading to the development of peripheral respiratory failure of different severity were distinguished: 1) predominating glossopharyngeal paralysis and 2) combination of glossopharyngeal paralysis with grave generalized sensorimotor polyneuropathy (with pareses and paralyses of the respiratory muscles). The major quantitative parameters of pulmonary functions associated with various manifestations of respiratory failure are characterized. The significance of information on the type of dysfunction of vocal cords is emphasized. A high efficacy of a complex of respiratory reanimation used in the treatment of patients with peripheral respiratory failure is demonstrated.

[Prognostic significance of neurophysiological parameters in nontraumatic apallic syndrome]. / Prognosticheskoe znachenie neirofiziologicheskikh pokazatelei pri netravmaticheskom apallicheskom sindrome.

The time course of neurophysiological parameters (EEG, evoked potentials of various modalities, including P300, and polysomnography) was followed up in 10 patients with apallic syndrome (AS) of nontraumatic origin (heart arrest, stroke, neuroinfection, etc.) during the formation of the syndrome and the condition of various severity: incomplete formation of AS eventuating in gross psychoneurological defects and complete formation of AS (a stable vegetative state). A dynamic follow-up of not only EEG of awaken and sleeping patients, but of their evoked potentials, specifically somatosensory and P300, were shown to be significant for assessment of the course of AS and prediction of its outcome.

[Changes in plasma osmolality in patients in the most acute phase of a stroke]. / Izmeneniia osmolial'nosti plazmy krovi u bol'nykh v ostreishei faze insul'ta.

Monitoring of plasma osmolality (PO) in patients with cerebral stroke revealed the most marked changes in hemorrhagic stroke. The presence of renal failure and hyperglycemia aggravated disorders of osmotic homeostasis. The value of PO adequately reflected the severity of the state of the patients. Stable hyperosmolality and an increase in the difference between the measured and calculated PO over 30 mOsm in the acutest phase of stroke were poor prognostic signs. Determination of PO along with other traditional tests (measurement of sodium, potassium, urea and glucose) yields important information for the correct treatment of patients in the acutest phase of cerebral stroke.