[Control and assessment of the quality of professional competence among physicians and students]. / Kontrol' i otsenka kachestva znanii studentov i vrachei.

The paper presents a new test method of control which permits to estimate objectively both formal knowledges of students, hospital physicians, post-graduates, physicians and their ability for logical reasoning, for determination of cause-effect relationships between separate phenomena. The list of the standards generally accepted for the test's tasks is proposed as well as recommendations for the users are given. 6 variations of the test's tasks are presented as the examples.

Clinical-neurophysiological features of motor lesions in patients with post-stroke epilepsy.

Twenty-two patients with post-stroke epilepsy (group 1) were studied, along with 30 stroke patients without epilepsy (group 2). Bilateral (on both the paralyzed and intact sides) decreases in the central conduction time (CCT) along the pyramidal tract were found in group 1, which were not seen in group 2, who had similarly severe motor lesions (p < 0.01). The tendency to decreased CCT was also seen 5-6 days after ischemic stroke in patients without epileptic manifestations, though CCT in this group increased by day 10-14; low values persisted in group 1 for prolonged periods. The facilitation differentiation (deltaF, the difference in CCT between resting and effort conditions) was also found to increase. In patients with post-stroke epilepsy, motor lesions were characterized by higher levels of muscle tone than in other stroke patients, though the levels of paralysis were similar.

[Disorders of muscle tonus and their treatment with sirdalud in patients in the early recovery period of ischemic stroke]. / Narusheniia myshechnogo tonusa i ikh lechenie sirdaludom u bol'nykh v rannem vosstanovitel'nom periode ishemicheskogo insul'ta.

The paper presents the results of clinical and neurophysiologic study of muscular tonus in 94 patients aged 42-70 years in early recovery after ischemic stroke. Selective role of spasticity was estimated in clinical pattern of motor disorders in groups of the patients with different disorders of muscular tonus with the same degree of paresis. Efficiency of antispastic preparation sirdalud was analyzed in 28 patients from this group. Sirdalud in daily dose of 6-12 mg in patients with prevalence of a spasticity in a clinical picture of the paresis and with either moderate or manifested degree of paresis of the extremities has significant antispastic effect without any decrease of muscular strength, which, in turn, increases the degree of restoration of motor functions.

[Clinical neuropsychological aspects of motor disorders in patients with post-CVA epilepsy]. / Kliniko-neirofiziologicheskie osobennosti dvigatel'nykh narushenii u bol'nykh s postinsul'tnoi épilepsiei.

The study included 22 patients with poststroke epilepsy (group 1) and 30 patients with stroke without epilepsy (group 2). A bilateral decrease of the time of central conduction (TCC) through pyramidal path (both on the paretic and intact side) was revealed in group 1. This was not observed in patients of group 2 with similar gravity of motor disorders (p < 0.01). Tendency to TCC decrease was also observed in patients without epileptic disorders by day 5-6 after ischemic stroke. However, TCC values were increased in such patients by day 10-14. Low indices persisted for a long time in patients with poststroke. There was also an increase of delta index of facilitation (the difference between TCC in rest and in muscle effort). It was also found that motor disorders in the group of patients with poststroke epilepsy were characterised by higher muscular tone than in poststroke patients with the same degree of the paresis.

[Epilepsy in patients with ischemic brain disease]. / Epilepsiia u bol'nykh s ishemicheskoi bolezn'iu golovnogo mozga.

The paper presents the results of follow-up study of 610 patients with ischemic stroke. In 52 patients (8.6%) there was observed symptomatic epilepsy conditioned by local causes (2 and more epileptic fits in anamnesis). The age of the onset of epileptic seizures was in the range 50-69 years, and men prevailed. From all 52 patients with episyndrome 36 had only one stroke, 16 patients-two and more strokes. 14 patients had fits before the stroke development. Meanwhile in 10 patients the fits were the first stroke symptoms (early) and in 28 individuals the fits arose 7 days after the stroke development (late). Significantly more severe disorders of dynamic praxis were revealed in psychologic examination of the patients with secondary generalized fits than of ones with partial seizures. Pathogenetic and clinical aspects of vascular epilepsy, interactions between transitory ischemic attacks and the fits which developed before the stroke are considered.

[The metabolic therapy of ischemic stroke: the use of nootropil]. / Metabolicheskaia terapiia ishemicheskogo insul'ta: primenenie nootropila.

54 patients were treated by notropil (pyracetam). The results of therapy were evaluated statistically according to a number of clinical scales and neurophysiologic indices (EEG and evoked potentials with mapping of bioelectric activity). The results were compared with the data about 56 patients of the control group which were treated by traditional method without application of notropil. Notropil was applied by two ways: small doses (4-12 g daily) during 5 days or high doses (10-12 g daily) during 30 days from the moment when the patient admitted to the hospital. Intravenous injections of the drug were used in all cases as well as its internal administration. It was showed either efficiency of the drug, especially in high doses, in early beginning of the treatment and its duration for at least 30 days or good tolerance of the drug. Authors supposed that application of pyracetam is not adequate in strokes with severe disorders of consciousness and cerebral edema.

[Nootropil in the treatment of disorders of the higher mental functions in patients with an ischemic stroke]. / Nootropil v lechenii narushenii vysshikh psikhicheskikh funktsii u bol'nykh s ishemicheskim insul'tom.

47 patients with acute ischemic stroke were treated with nootropil (pyracetam, UCB, Belgium) from the first day of the disease (12 g, intravenously, by drops during 2 weeks, then 4.8 g, per os) on the background of basic therapy. There was revealed increase of spontaneous activity, expressive and impulsive speech, audio- and speaking memory (especially delayed memory), tactile, acoustic and visual gnosis, space praxis. There was observed more pronounced positive dynamics of functions of damaged hemisphere in patients with localisation of ischemic focus in left hemisphere. Meanwhile restoration was slower when ischemic focus was localized in right hemisphere. Restoration of high mental functions occurred to be faster during nootropil treatment as compared with basic therapy only. The conclusion was made that nootropil can be prescribed for the patients with hemispheric ischemic stroke and especially for the patients with alterations of cerebral circulation in system of internal carotid artery including such disturbances on the background of insufficiency of circulation in vertebrobasilar system.

[Lamiktal in the treatment of epilepsy patients]. / Lamiktal v lechenii bol'nykh épilepsiei.

Lamictal (Lamotrigin) action was studied in 61 patients with partial and generalized epileptic seizures (not fewer than twice a month). Most of the patients received Lamictal in doses of 200-300 mg daily as well as other antiepileptic medications (before lamictal all patients were treated without effect with various antiepileptic medications). Effectiveness of treatment with lamictal includes: the cessation of epileptic attacks (5 patients), its more rare appearance (31 patients), transformation into more light fits (15 patients). Lamictal has a broad spectrum of antiepileptic activity: it stops generalized tonic-clonic seizures, absences, simple and complex partial seizures as well as secondarily generalized tonic-clonic seizures. The medication is also effective in patients with psychopathologic symptoms.

[The basic factors affecting outcomes in strokes]. / Osnovnye faktory, vliiaiushchie na iskhody insul'tov.

Outcomes in 1102 patients with 3 main types of stroke have been analysed to determine the significance of basic stroke outcome predictors. They are: type of the stroke, location of the focus, gravity of the patient's condition when the first aid is performed, spectrum of hospital facilities, diseases of the patient before and besides the stroke. A decrease of the mortality rate and optimal level of ADL score after stroke can be provided in cases when intensive care units-general hospitals are the first step of treatment.

[The clinico-neurophysiological study of the effect of cerebrolysin on brain function in the acute and early recovery periods of hemispheric ischemic stroke]. / Kliniko-neirofiziologicheskoe issledovanie vliianiia tserebrolizina na funktsional'noe sostoianie golovnogo mozga v ostrom i rannem vosstanovitel'nom periodakh polusharnogo ishemicheskogo insul'ta.

Thirty patients with acute ischemic stroke and at early terms of postapoplectic recovery received cerebrolysin in daily doses 10, 20 and 30 ml for 5 days or 10 ml, i. v. for 10 days, respectively. The patients were examined for neurological status and cerebral function. In acute stroke the highest effect occurred in the affection of moderate severity. In severe stroke the drug stimulated recovery of impaired functions which tended to restore more quickly than in control subjects. In early convalescents cerebrolysin improved motor functions. Details of the results of the combined neurophysiological examination in the course of the treatment are discussed.

[The complex clinico-electrophysiological assessment of the motor disorders in patients in the early period of recovery from an ischemic stroke]. / Kompleksnaia élektrofiziologicheskaia otsenka dvigatel'nykh narushenii u bol'nykh v rannem vosstanovitel'nom periode ishemicheskogo insul'ta.

A neurophysiological analysis of motor affections has been made in post-apoplectic patients during early convalescence. Altogether 26 patients aged 45-68 were examined on week 3-4 since ischemic hemispheric apoplexy. Magnetic stimulation of cerebral cortex motor zones, measurements of M-response and evoked skin sympathetic potential. Mild or moderate motor dysfunctions were characterized by reduced amplitude of the M-response and prolonged central pyramid conduction on the affected side. Severe paresis is associated with no M-response to magnetic stimulation of the cortex on the affected side. Pathogenetic mechanisms of the above disorders and their implications for treatment and rehabilitation are discussed.

[Ultrastructural aspects of the secondary brain stem syndrome in hemorrhages and infarcts in the cerebral hemispheres]. / Ul'trastrukturnye aspekty vtorichnogo stvolovogo sindroma pri krovoizliianiiakh i infarktakh v bol'shikh polushariiakh golovnogo mozga.

Ultrastructural aspects of the secondary brain stem syndrome in patients with hemorrhages and infarcts in the brain hemispheres are considered. The secondary brain stem syndrome is manifested by diverse clinical symptomatology suggestive of dysfunction of different levels of the brain stem: a diminished level of awakening, oculomotor disturbances, changes in the muscle tone and reflexes, cardiorespiratory and other vegetative disorders. Examining the reticular formation of the brain stem under the electron microscope the authors revealed changes in neurons in the form of chromatolysis, an increase in the cellular cytoplasm of the number of lipid inclusions and lysosomes, swelling of mitochondria and (less frequently) the appearance of cells with an elevated osmiophilia of the cytoplasm. Also observed was a systemic increase in lysosomes and lipid granules in capillary structures, and in glial and nervous cells. The pathogenetic factors of secondary brain stem syndrome are discussed.

[Ultrastructural aspects of acute cerebral ischemia during nootropil administration (experimental study)]. / Ul'trastrukturnye aspekty ostroi ishemii golovnogo mozga v usloviiakh primeneniia nootropila (éksperimental'noe issledovanie).

Electron microscopy of the sensomotor cortex in 27 rats was performed at varying times (1, 3, 7 days) after arteria carotis communis occlusion. Three groups of rats (5 rats in every group) were treated by nootropil (500 mg/kg daily) in accordance with three time intervals. Control rats were undrugged. More preserved were neurons in the brain of rats treated by nootropil. Neuronal organelles had rare signs of irreversible damages. Membranes were more often preserved, organelles fragmentation and vacuolization were less pronounced. The experimental rats showed neurons containing numerous ribosomes and small new-formed mitochondria. The difference in neuronal structure in treated and untreated rats became more distinct 3-7 days after occlusion. The results obtained are suggested to be connected with the drug ability to normalize ATP metabolism, to stimulate phospholipid synthesis and ribosome function and to increase glucose utilization. The problem of using GABA derivatives in conditions of the most acute brain ischemia is discussed.

[Status of cerebral capillary circulation during ischemia with barbiturate protection]. / Sostoianie kapilliarnogo krovoobrashcheniia mozga pri ishemii v usloviiakh barbituratnoi zashchity.

Experiments on 78 albino rats with ligated common carotid arteries were carried out to study the effect of a barbiturate agent (barbamil) administered in a dose of 150 mg/kg of animal body weight on cerebral capillary circulation at different terms of ischemia (1, 3 hours, 1, 3, 7, 14 days). The findings obtained during follow-up point to a beneficial effect of the barbiturate on the structures of the capillary wall (endotheliocytes, pericytes, basal membrane). Furthermore, the drug appears to maintain the capillary lumen and the normal level of capillary permeability, which contributes to the improvement of microcirculation in ischemia. The paper also describes some ultrastructural mechanisms of the decrease and stabilization of the cerebral capillary blood flow under the barbiturate impact due to endothelial synapses blockade, inhibition of vasoconstrictive mechanisms and stabilization of the membrane structures of the capillary network.

[Diagnosis and treatment and preventive measures in the presence of initial manifestations of insufficient cerebral blood supply]. / Diagnostika i lechebno-profilakticheskie meropriiatiia pri nachal'nykh proiavleniiakh nedostatochnosti krovosnabzheniia mozga.

Electrophysiological, ultrasound, biochemical, and psychological studies in 222 patients with initial manifestations of brain blood supply insufficiency (IMBBSI) are presented. A scheme for diagnostic, treatment and dispensary system is offered, principles of IMBBSI therapy are given into account. IMBBSI differentiated treatment leads to steady disappearance of its clinical manifestations in 28.3% of patients and to significant improvement in 58,1% (the last group of patients needs supporting therapy).