[The rate of hyponatremia in neurosurgical patients (comparison between the data from the Burdenko Neurosurgical Instutite and the literature) and recommendations for the diagnosis and treatment].

UNLABELLED: Hyponatremia is a relatively frequent and serious complication in patients with various neurosurgical pathologies. OBJECTIVE: This study is aimed at assessing the incidence of hyponatremia in neurosurgical patients depending on the pathology. MATERIAL AND METHODS: This paper presents a retrospective analysis 39 479 cases of patients operated on at the Burdenko Neurosurgical Institute from 2008 to 2014. RESULTS: A total of 785 hyponatremic patients with Na level lower than 130 mmol/l (2% of all operated patients) were identified. Mortality in patients with hyponatremia was 14.3%, which is tenfold higher compared to the rest of population of patients without hyponatremia who were operated on during the same period. In adults, hyponatremia most frequently occurred after resection of craniopharyngiomas (11%) and as a result of acute cerebrovascular accident (22%). In children, it occurred after resection of craniopharyngiomas (10%), astrocytomas (7%), ependymomas (24%), and germ cell tumors (10.5%). CONCLUSION: This study, which was mainly statistical one, was not aimed at detailed investigation of hyponatremia in different groups of neurosurgical patients. We only tried to draw the attention of various experts to those categories of patients, where focused and in-depth developments are more than important. Obviously, already gained international experience should be taken into account for this PURPOSE: Therefore, this article presents the literature data on the etiology and pathogenesis of hyponatremia. We describe the details of the various classifications of hyponatremia, its clinical symptoms, diagnosis, and treatments, primarily based on the recommendations of the last European consensus of various specialists (2014).

[Clinical and morphological characteristics, diagnostic criteria, and outcomes of surgical treatment of TSH-secreting pituitary adenomas]. / Kliniko-morfologicheskie kharakteristiki, diagnosticheskie kriterii i rezul'taty khirurgicheskogo lecheniya TTG-sekretiruyushchikh adenom gipofiza.

Thyrotropinomas (TSH-secreting tumors) are a rare type of pituitary adenomas, which account for about 0.5-2.0% of all pituitary tumors. The criterion of thyrotropinoma is visualization of the tumor in the presence of a normal or elevated level of the thyroid-stimulating hormone (TSH) in the blood and elevated concentrations of free T4 (fT4) and free T3 (fT3). OBJECTIVE: To study the clinical, diagnostic, and morphological characteristics and treatment outcomes of TSH-secreting pituitary tumors. MATERIAL AND METHODS: The study included 21 patients aged from 15 to 67 years with pituitary adenoma and a normal or elevated blood TSH level combined with elevated fT4 and fT3 levels who were operated on at the Neurosurgical Institute in the period between 2002 and 2015. Before surgery, in the early postoperative period, and 6 months after surgery, the patients were tested for levels of TSH, fT4, fT3, prolactin, cortisol, the luteinizing hormone (LH), the follicle-stimulating hormone (FSH), estradiol/testosterone, and the insulin-like growth factor (IGF-1). The thyroid status was evaluated using the following reference values: TSH, 0.4-4.0 mIU/L; fT4, 11.5-22.7 pmol/L; fT3, 3.5-6.5 pmol/L. An immunohistochemical study of material was performed with antibodies to TSH, PRL, GH, ACTH, LH, FSH, and Ki-67 (MiB-1 clone); in 13 cases, we used tests with antibodies to somatostatin receptors type 2 and 5 and to D2 subtype dopamine receptors. RESULTS: Thyrotropinomas were detected in patients aged from 15 to 67 years (median, 39 years), with an equal rate in males (48%) and females (52%). Before admission to the Neurosurgical Institute, 11 (52%) patients were erroneously diagnosed with primary hyperthyroidism; based on the diagnosis, 7 of these patients underwent surgery on the thyroid gland and/or received thyrostatics (4 cases). Hyperthyroidism symptoms were observed in 16 (76%) patients. The blood level of TSH was 2.47-38.4 mIU/L (median, 6.56); fT4, 22.8-54.8 nmol/L (median, 36); fT3, 4.24-12.9 pmol/L (median, 9.66). Tumors had the endosellar localization in 4 (19%) cases and the endo-extrasellar localization in 17 (91%) cases. Total tumor resection was performed in 7 (33%) patients. All these tumors had the endosellar and endo-suprasellar localization. No total resection was performed in patients with infiltrative growth of adenoma (invading the skull base structures). An immunohistochemical study of tumor resection specimens detected only TSH expression in 3 (14%) cases; 18 (86%) tumors were plurihormonal and secreted TSH and GH and/or PRL. Of 13 tumors, expression of the type 2 dopamine receptor was detected in 9 (69%) cases; expression of somatostatin receptors type 5 and type 2 was found in 6 (46%) and 2 (15%) cases, respectively. CONCLUSION: The criterion for total tumor resection was a postoperative decrease in the TSH level to 0.1 mIU/L or less. Total resection was performed in 33% of patients with tumors of only the endosellar and endo-suprasellar localization. In most cases, tumors were plurihormonal and secreted TSH and GH and/or PRL.

[Endovascular treatment of large and giant intracranial aneurysms using flow-diverting stents].

OBJECTIVE: The objective was to evaluate the efficacy of treatment of patients with large and giant cerebral arterial aneurysms using flow-diverting stents (FDSs). MATERIAL AND METHODS: The treatment outcomes of 210 patients with large and giant intracranial aneurysms were analyzed. The study included patients with both asymptomatic and symptomatic aneurysms (manifested by SAH or pseudotumorous course). The rate of giant aneurysms was 62.3%. RESULTS: The technical success rate was 96%. In the perioperative period, the rate of clinically significant complications was 2.8%; the postoperative mortality was 3.3%. In the long-term period, total thrombosis of the aneurysm was observed in the majority of cases (80%) in the period from 4 to 12 months. Complete regression of clinical symptoms was observed in 26% of the cases, partial regression in 35%, and deterioration in 6% (of them, 4.9% of the cases were clinically significant). The long-term mortality was 2.5%. CONCLUSION: FDS is a highly efficient device for remodeling of the arterial lumen at the level of large, giant and fusiform intracranial aneurysms that significantly reduces the number of deconstructive operations and decreases the risk of ischemic complications of endovascular treatment for this complex vascular pathology.

[Requirements for analytical quality: use of the concept of biological variation].

By using a clinical biochemistry laboratory as an example, the authors show how the analytical quality system practically operates. The advantages of using a three-level model for analytical quality requirements on the basis of biological variations in analytes are discussed. Only does the use of a few normative documents present a possibility of creating an adequate quality system in a specific laboratory. The long-term coefficient of analytical variation is the most important characteristic of analytical quality and a necessary component of the day-to-day work of the laboratory. The level of quality is shown for 27 analytes. Despite the fact that the laboratory uses the same analytical systems as in the world, the level of analytical quality has turned out to be lower than in the best laboratories of Europe.

[The estimated glomerular filtration rate in outpatients].

The glomerular filtration rate (GFR) calculated by the MDRD formula was estimated in a population of outpatients aged over 18 years. Serum creatinine concentrations were measured, by using 5 analytical systems: Abbott Architect (n = 9054), Roche Modular (n = 22947), Roche Integra 400 (n = 2748), Roche Integra 700 (n = 8350), and Roche Hitachi (n = 20196). For 4 systems, the distribution of GFR differed little. The exception was the Roche Hitachi analytical system where TE and bias were higher than the acceptable requirements. Therefore, with this system, the proportion of outpatients with a GFR of < 60 ml/min per 1.73 m2 was twice higher than that with the use other analytical systems. Such publications should contain data on the analytical quality of measurement of serum creatinine concentrations in the range of 88 to 140 micromol/l. The estimated GFR may be clinically used provided that the performance of this test will be better than the acceptable analytical quality requirements established by the working NKDEP group.

[Testing the acceptability of applied reference intervals, by using serum creatinine as an example].

Unfortunately, the international standard ISO 15189:2003 does not give clear guidelines for the choice, development, and testing the acceptability of reference intervals. The so-called normalization of the frequency distribution of serum creatinine concentrations was carried out in the population of outpatients above 18 years of age. Creatinine concentrations were measured, using 5 analytical systems: Abbott Architect (n=9054), Roche Modular (n = 22,947), Roche Integra 400 (n=2748), Roche Integra 700 (n=8350), and Roche Hitachi (n = 20,196). The obtained 95% confidence intervals were compared with the published reference intervals. It is shown that this approach may be valuable in the assessment of acceptability of the used reference intervals, by taking into account the analytical quality of measurement of creatinine concentrations. Whether there is an association of the analytical quality of measurement of creatinine concentrations and their biological variations with the approaches to developing and using the reference intervals in clinical practice is discussed.

[Lipid peroxidation in the cyst fluid of craniopharyngiomas]. / Perekisnoe okislenie lipidov v kistoznoi zhidkosti kraniofaringiom.

Comparing of the craniopharyngiomas cyst fluid, collected during the surgery, with blood plasma revealed significantly enhanced lipid peroxidation and lactate accumulation in tumour cysts contents. These processes were usually more prominent in endosuprasellar than in suprasellar craniopharyngiomas. The maximum of free radical formation in conjunction with the lowest level of malondialdehyde (MDA) was observed in primary tumours with relatively high proliferation rate. Controversial parameters ratio characterised the recurrent craniopharyngiomas, and in cyst fluids of the primary tumours with low proliferation rate the medium parameter's values were observed. Thus, the estimation of free radical formation level and MDA concentration in cyst fluid of craniopharyngioma seems to be prognostic for the tumour recurrence.

[Cerebral hemodynamics and metabolism in the acute stage of cerebral aneurysm rupture]. / Tserebral'naia gemodinamika i metabolizm v ostroi stadii razryva anevrizm golovnogo mozga.

The relationship between lipid peroxidation products and the severity of arterial spasm was studied in 86 patients. For this, the level of radical production, the content of the end lipid peroxidation product malonic dialdehyde and the overall antioxidative activity of lumbar cerebrospinal fluid were determined during 24-hour Doppler monitoring of blood flow in the middle cerebral and internal carotid arteries. Following subarachnoidal hemorrhage, the activation of lipid peroxidation processes was shown to correlate with the severity of arterial spasm and it is likely to contribute to the development of late ischemias. Nimotop used to treat patients with significant arterial spasm caused a reduction in the rate of free radical lipid peroxidation to that characteristic for patients with moderate spasm. The findings suggest that it is expedient of including antioxidants into the combined therapy of patients with acute subarachnoidal hemorrhage.

[The role of biochemical processes in the pathogenesis of complicated hydrocephalus in children]. / O roli biokhimicheskikh protsessov v patogeneze oslozhnennoi vodianki golovnogo mozga u detei.

Spinal fluid radical formation levels, malonic dialdehyde concentrations, and intrinsic antioxidative activity were studied in 84 patients with hydrocephalus. The findings suggest that there is a considerable activation of free radical reactions and lipid peroxidation, as well as a reduction in antioxidative activity. These changes were most drastically profound in children with inflammation-complicated hydrocephalus with spinal fluid hemorrhagic changes in particular. Timely correction of impaired energy exchange in children by using antioxidants and nootropics promotes the arrest of inflammation and prevents a number of postoperative complications.

[Study of free radical oxidation of lipids in cerebrospinal fluid of hydrocephalic children]. / Issledovanie protsessov svobodnoradikal'nogo okisleniia lipidov v likvore detei s gidrotsevaliei.

The levels of free radical production, malondialdehyde concentration and antioxidant activity were estimated in ventricular liquor of the infants with primary hydrocephalus. It was shown that even in the case of uncomplicated hydrocephalus significant disorders in brain metabolism took place. In the patients with inflammatory or hemorrhagic complications the levels of malondialdehyde and free radicals were markedly increased as compared to the infants with "pure" hydrocephalus. The most significant disorders were revealed in the case of hemorrhagic complications. These data indicate the necessity of lipid peroxidation evaluation in liquor of the patients with hydrocephalus and help to workout indications for antioxidants including into the common therapy of this decrease.

[Endogenous intoxication and its treatment with sodium hypochlorite in neurosurgical patients]. / Endogennaia intoksikatsiia i ee lechenie s primeneniem gipokhlorita natriia u neiroreanimatsionnykh bol'nykh.

Blood plasma levels of medium-mass molecules (MMM), antioxidant activity (AOA), and malonic dialdehyde (MDA) were measured in 51 neurosurgical patients before and directly and 24 h after intravenous drip infusion of sodium hypochlorite (SHC) solution. Preliminary in vitro studies showed the most expressed drop of initially high MDA and MMM levels to be associated with an increase of AOA. It was observed at SHC concentration of 0.05 mg/ml, corresponding to infusion of SHC in a concentration of 600 mg/liter in 0.1 of the total circulating blood volume. Even a single dose of SHC alleviated endogenous intoxication and decreased the concentration of MMM and lipid peroxidation products. The proper AOA of the blood did not drop in this case, and in patients with initially low AOA it appreciably increased. Infusion of SHC normalized the values of Kp, which reflected its high detoxifying activity in endogenous poisoning caused mainly by inflammatory changes.