[REACTIVITY AND RESISTANCE OF THE SPINAL STRUCTURES WHEN PERFORMING INSTRUMENTAL CORRECTION OF SPINAL DEFORMITIES].

The aim of the study was the electroneuromyographic evaluation of the spinal cord pyramidal structures reactivity and resistance in response to the impact of intraoperative factors associated with the application of technologies instrumental correction of spinal deformities of various etiologies and degrees of severity, realized with the help of submersible transpedicular fixation systems. Before treatment and 4-31 (9.6 ± 0.3) days after surgery using methods of global and stimulation (M-responses) electroneuromyography were examined 135 patients 8-50 (16.4 ± 0.6) years (42 male, 93 female) with spinal deformities of various etiologies and severity. The intrao perative maximum angle correction of the spinal column ranged from 3° to 95° (37.2 ± 1.5°). To assess the reactivity of the spinal cord structures located at the top of the primary arc deformation used integral index - the index of sensorimotor deficit (ISD). The lowest values of ISD and most distinct postoperative negative trends of this indicator were observed in persons with spinal deformities of neuromuscular etiology.

Effect of Uranium and Thorium Radionuclides on Biochemical Characteristics of Duschekia fruticosa in "Soil-Plant" System.

The biochemical characteristics of Duschekiafruticosa, grown for a long time under a variety of exposure doses of natural background radiation (up to 150 µR/h) was studied. Uranium was found to make the dominant contribution to the y-background exposure doses. The pH-values and the content of organic matter in soils within the surveyed territory remained unchanged. Accumulation of radionuclides of uranium and thorium in the "soil-plant" system was studied. It is shown for the D. fruticosa that U and Th uptake decreased with y-background increasing. Study of anti-free radical and anti-peroxide cells' protection system indicated a balanced activity of prooxidant-antioxidant systems in the cells of the D. fruticosa leaves. The combined effect of incorporated uranium and thorium is accompanied by a significant increase in chlorophyll content in D. fruticosa.

[ENMG-assessment of efficiency of temporal epidural electroneurostimulation in combined with robotic kinesotherapy in the treatment of patients with spinal cord injury consequences].

The goal of this study was to ENMG-assess effectiveness of the short combined neurorehabilitation course (temporal epidural stimulation of the spinal cord combined with a robotic kinesotherapy) in the restorative treatment of patients with traumatic spinal cord disease. Before and after completion of the combined instrumental neurorehabilitation (course duration--2-3 weeks) were tested 75 patients with spinal cord injury consequences. The authors used global and stimulation (H-reflex, M-response) electromyography methods. On the ENMG-data basis were calculated indices of sensorimotor deficit (ISD) and their postrehabilitation trends. ENMG-signs of sensorimotor deficit regression in the lower extremities were observed in 46.6% of events, in the upper extremities (if damaged cervical spine)--in 78.6% of events. The stabilizing effect of the used neurorehabilitation technology was identified an average of 24.0% of events. In 18.8% of events, the using of the combined neurorehabilitation technology has been ineffective. As indications for the use of combined neurorehabilitation courses series may be employed ENMG-signs of the partial corticospinal tracts conduction safety and a positive ISD trend after the each course completion.

[Neurophysiological correlates of pyramidal insufficiency of ischemic and traumatic genesis in conditions of distraction osteosynthesis application].

Analyzed main trends in variations of quantitative electroneuromyographic characteristics at patients with stroke and severe craniocerebral trauma consequences in the treatment process using transosseous distraction osteosynthesis. Studied specific features of central nervous system reaction on present surgical treatment at patients depending on age, etiology and severity of initial brain structures damage. Formulated notions about staging and mechanisms of reactive change in the brain-cortex under the influence of rehabilitation by transosseous distraction osteosynthesis at patients of noted nosological groups.

[Efficacy of motor control at patients with cerebral hemiparesis in rehabilitation conditions with application of transosseous distraction cranio-osteosynthesis].

To study influence of transosseous distraction cranio-osteosynthesis on functional state of neuromotor system at patients with hemispheric stroke consequences, severe craniocerebral trauma analyzed dynamics of electroneuromyography index--cerebrospinal index, obtained by testing of extremities muscles at 28 persons in residual disease period. Data analysis obtained in control period testify to positive cerebrospinal index dynamics is maximum evident in long-term post-operative period and on leads from upper paretic limb. Thus, electrophysiologically identified increase of motor control efficacy of paretic limbs muscles at patients with cerebral alteration consequences in treatment by transosseous distraction cranio-osteosynthesis.

[Voluntary control of lengthened and intact limbs muscles tension under different force load ranges].

The data are presented which supporting the hypothesis of the presence of isometric force load zone, within which the subjects tested organize the voluntary muscle tension controlling with maximal accuracy and minimal specific power expenses, estimated indirectly, by the ratio of the surface electromyogram (EMG) area (integral of EMG) to force moment impulse. The asymmetries of the integral values of visual-and-motor tracking have been analyzed as well using isometric control organs in 23 patients at the age of 15-35 years (6 - males and 17 - females) in different periods after surgical elimination of lower limb length discrepancies. Poorly marked zone of minimization of integral discrete visual-and-motor tracking estimates, manifesting itself within 25-35% of the maximal force of the muscle group tested (foot dorsal flexors) has been noted in tested healthy subjects (26 normal males at the age of 19-39 years) and orthopedic patients (intact limb). The zone of "optimal' loads is marked more clearly on patients' lengthening side with the tendency towards its shift to the area of weaker forces.

[Clinical and neurophysiological characteristics of motor cortical responsiveness during prolonged cranial osteoplasty]. / Kliniko-neirofiziologicheskie kharakteristiki reaktivnosti motornoi kory golovnogo mozga v usloviiakh prolongirovannoi kranioosteoplastiki.

The data of global and stimulation poly-EMG were used to estimate the outcomes of multimodality treatment of sequelae of brain injury and stroke, which was based on the vasoactive effects of prolonged cranial osteoplasty. Thirteen patients (7 males and 6 females) aged 19 to 64 (mean 42 +/- 4) years who had signs of left- (n = 2) and right-sided (n = 11) spastic hemiparesis. Global and stimulation poly-EMG, which involved recording and analysis of resting and total EMG under the maximum voluntary tension, M-waves H-reflexes, transcranially evoked potentials. The muscles of the shoulder, forearm, hand, femur, leg, and foot were studied. The surgical procedure developed at the Russian Research Center "VTO" for stimulation of cerebral blood flow in combination with conventional conservative treatments (physiotherapy, therapeutical exercises, and adequate drug therapy) was shown to increase the transmission coefficient of an efferent signal in the motor cortex-spinal motor neurons-muscle system, which is clinically accompanied by improved coordination of simple and complex movements realized with the participation of the muscles of both the paretic and contralateral extremity. The ambiguous effects of the vasoactive factors of prolonged osteoplasty on the functions of unequally modal pathologically changed cerebral motor structures were noted. The findings may be considered as evidence for the low traumatic ability of the VTO's techniques for replacing posttraumatic defects of skull vault bones.

[The functional status of the cerebral cortex after replacement of skull base bone defects]. / Funktsional'noe sostoianie kory golovnogo mozga pri zameshchenii defektov kostei svoda cherepa.

The functional status of the cerebral cortex was evaluated by EEG before and different periods after prolonged cranial osteoplasty made by the type of replacement of skull base bone defects in patients with dyscirculatory encephalopathies of various genesis. Seven patients aged 20 to 50 years undergone repair of skull base bone defects (both posttraumatic and simulated) by the procedures developed at the Russian Research Center "VTO" were examined. The bioelectrical activity of the brain was recorded and analyzed on a PEGASUS digital 16-channel EEG system (EMS, Austria) by using the Fourie prompt conversion test (spectral analysis) and amplitude-frequency mapping. After multimodality treatment, all the patients showed a positive changes in the whole range of EEG parameters, which appeared as an increase in basic rhythm power, a decrease in the focal area of slow-wave activity and in the interhemispheral asymmetry coefficient, which in combination of neurological regression is regarded as indirect evidence for the vasoactivity of prolonged cranial osteoplasty.

[Responsiveness and resistance of spinal cord structures in patients with closed thoracic and lumbar spinal injuries: neurophysiological and clinical aspects]. / Neirofiziologicheskie i klinicheskie aspekty reaktivnosti i rezistentnosti spinnomozgovykh struktur u bol'nykh s zakrytymi povrezhdeniiami grudnogo i poiasnichnogo otdelov pozvonochnika.

The study was undertaken to explore the time course of parameters of neuromotor dysfunction in patients with thoracic and lumbar spinal fractures characterized by the varying degrees of neurological symptoms. The study was based on the results of complex neurophysiological testing (global and stimulation electroneuromyography (EMG) in 45 patients with thoracic and lumbar spinal fractures who had been admitted to the "VTO" Russian Research Center without complications. The patients were divided into 2 groups: 1) 17 patients without neurological disorders and 2) 28 with mild neurological ones. There was evidence that there were no complicated vertebral injuries. Group 1 patients were found to have steady-state changes in the EMG structure, lower voluntary and involuntary activities (M responses) of the muscles of the hip, leg, and foot, enhanced reflex excitability of leg muscles, EMG signs of spasticity and irritation of segmental radicular structures, long-term asymmetry virtually in all EMG parameters. It was also ascertained that the group of patients with uncomplicated vertebral fractures was represented by individuals having more fitness or those belonging to the so-called "muscular" somato-type. The findings lead to the conclusion that the VTO treatment of vertebrospinal injuries, that is based on the use of a refinement of an external spinal fixation apparatus, creates necessary prerequisites for prevention of further development of neurological deficit and for the optimal course of compensatory-reparative processes in the damaged spinal cord structures.

Small epidemic in Zanzibar -- but for how long? Country focus: Zanzibar.

PIP: 1000 cases of HIV infection and 590 cases of AIDS have been reported in Zanzibar since the first AIDS case was reported in late 1986. HIV rates are as high as 17.2% among tuberculosis patients, 11.6% among sexually transmitted disease patients, and 1.67% among antenatal clinic attenders in urban areas. The majority of known HIV and AIDS cases come from urban areas. The World Health Organization estimates that 5000 people are infected across the islands, projected to reach 10,000 by 2000 and 13,500 by 2005. The main mode of viral transmission seems to be heterosexual and the increase in HIV is most rapid among teenagers and youths aged 20-24 years. The government of Zanzibar responded to the AIDS epidemic 2 months after the first AIDS case was diagnosed and the Ministry of Health's Zanzibar National AIDS Control Program (ZACP) is currently implementing its second medium-term program. However, there have not been enough funds to cover most of the planned activities. The author describes efforts to ensure a safe blood supply; information, education, and communication; donor support; the multisectoral approach; and the new structure developed for ZACP.^ieng

Malaric placentas. A quantitative study and clinico-pathological correlations.

A histological and morphometric study was conducted on 372 placentae out of a total 440 delivered in Zanzibar. Fibrin (F), intervillous space (IVS) and Villi (V) relative volumes were determined by the point-counting system and the ratio of syncytium to blood capillaries by the linear intercept method. Parasitemia load and inflammatory reaction were graded semiquantitatively by the use of a 1 mm square grid. Parasitised red cells identified active malaria (AM), the presence of malarial pigment only identified past malaria (PM), and the absence of both characterized non-malarial placentae (NM). AM(17.87%), PM(21.61%) and NM(60.52%) placentae did not vary significantly in weight. Newborns from AM had a significantly lower weight than those from PM and NM. Peripheral and placental parasitemia were not coincident. Placental parasitemia load increased parallel with birthweight. The latter decreased with the increasing severity of the inflammation, particularly with the prevalence of lymphocytes in the IVS. Significantly increased volume of F was found in AM and PM placentae, while no significant variation was noticed in IVS and V volumes. The syncytium/capillaries ratio was significantly increased in AM. We conclude that low birthweight in malaria is linked to IVS inflammation but not to F deposits or parasitemia load. Non-leukotactic lymphokines might play some role. Morphologic aspects bespeak for a less mature placenta than expected and this might represent an adaptive change.

Malarial infection and birthweight in urban Zanzibar, Tanzania.

In urban Zanzibar, Tanzania, 389 women with full-term pregnancies were studied to see what effect their infection with malaria (at delivery) had on the birthweight (BW) of their infants. The overall prevalence of low birthweight (LBW) (i.e. < 2500 g) was 3.9% (15 out of 389). Overall, 21.3% (82/384) of the women only had peripheral parasitaemias at delivery, 17.6% (58/329) only had active placental infections and 47.9% (157/328) had both. The youngest women (< 20 years), the primiparae and those with Plasmodium infection gave birth to neonates with relatively low mean BW. The lowest mean BW (2967 g) was found among the offspring of women with active placental infection (N = 58). The women with past/chronic infection (N = 73) or no infection (N = 201) generally produced heavier infants, with mean BW of 3242 and 3338 g, respectively. The women with active placental infection were also far more likely to have babies of LBW (15.5%) than those with past/chronic infection (1.4%) or no infection (1.5%). Multivariate analysis indicated that the highest relative risk of LBW (10.1, with a 95% confidence interval of 2.9-35.4) was associated with active placental infection, with no significant difference between primiparae and multiparae. In the study population, therefore, with its low prevalence of LBW, malaria infection increased the risk of LBW in full-term neonates by about 10-fold, with a population-attributable proportion of 55.4%.

PIP: 389 pregnant women admitted for full- term, uncomplicated delivery at the Regional Hospital on the island of Zanzibar (Tanzania) were recruited to study the effect of malarial infection on birth weight in an endemic area. 3.8% of all newborns weighed less than 2500 g (i.e., low birth weight [LBW]). 21.4% of all women had peripheral parasitemias but no active placental infection. 17.6% had active placental infection but no peripheral parasitemia. 47.9% had both active placental and peripheral infections. Logistic regression analysis revealed that active placental infection was associated with LBW (15.5% vs. 1.2%; relative risk [RR] = 10.1, population attributable proportion [PAP] = 61.4%; p = 0.003). Serum albumin level less than 2.5 mg/dl was also associated with LBW (11.8% vs. 1.2%; RR= 10.2, PAP = 61.%; p = 0.008). Overall malarial infection was associated with LBW (6.5% vs. 1.8%; RR = 3.5; PAP = 55.4%; p = 0.04). These findings suggest that placental malaria causes intrauterine growth retardation, leading to LBW newborns and that malarial preventive interventions in pregnant women are needed in Tanzania.

Malaria and anaemia in pregnant women in urban Zanzibar, Tanzania.

Severe anaemia in pregnancy is a major obstetric problem in malaria-endemic areas. This study reports a cross-sectional investigation of malaria infection and haematological values at delivery in 440 women from urban Zanzibar. Severe anaemia [with haemoglobin (Hb) < or = 7 g/dl] was identified in 36 women (9.3%) and mild anaemia (7 < Hb < 10 g/dl) in 269 (69.7%) while 81 women (21.0%) had normal Hb values. Malaria infection was diagnosed in 187/385 women (48.6%) on the basis of either peripheral blood examination or placental histology. Univariate analysis indicated that the proportion of women with anaemia was similar in those with (85%) and without (80%) malaria infection. However, when primigravidae were considered alone, malaria infection was significantly more frequent among anaemic women (65.2%) than in those with normal Hb values (40.0%). In the logistic regression analysis, including age, parity, education level, malaria and free serum iron as independent variables and anaemia (Hb < or = 10 g/dl) as response variable, the odds ratio (OR) for malaria infection was 1.2 (P > 0.1). However, a similar analysis indicated that malaria was significantly associated with anaemia in the primigravidae, with an OR of 3.2 (95% confidence interval: 1.1-9.6; P < 0.05). In conclusion, this cross-sectional investigation indicated that malaria plays a significant role in the determination of anaemia in primigravidae, but not in multiparae, in the urban study area.