[Efficacy and safety of glycine and limontar in the complex therapy of discirculatory encephalopathy and encephalopathy in diabetes mellitus type I].

One hundred and twelve patients with diabetes mellitus type I (DMTI) with different severity and compensation state of the disease were examined. A comparison group included 40 patients with discirculatory encephalopathy (DE). Patients with DMTI and DE were randomized to basic therapy (treatment of glycemia, vasoactive drugs) and treatment with glycine (0,1g) and limontar (0,25 g) 3 times a day. All patients underwent the complex examination including the assessment of neurological and neuropsychological status, the endocrinology clinical-laboratory study, ultrasonic dopplerography of head and neck vessels and transcranial dopplerography with vascular reactivity tests (response to nitroglycerin); direct ophtalmoscopy, the study of plate-let homeostasis. Efficacy and safety of treatment were assessed after 3 months. The dynamics of neurological and neuropsychological status, vascular reactivity results (the increase of number of patients with the adequate response to nitroglycerin), platelet aggregation (the reduction of aggregate size and aggregation velocity), microcirculation disorders (the increase of number of patients with non-proliferative retinopathy and the decrease of those with preproliferative one) were significantly better in the group treated with glycine and limontar. The treatment effect was higher in DMTI patients with encephalopathy that was likely explained by the greater role of microcirculation mechanisms in the formation of encephalopathy in patients with diabetes mellitus.

[Efficacy and safety of the combined therapy with citicholine and actovegin in the acute period of ischemic stroke].

One hundred and four patients with acute carotid ischemic stroke were included in the study. Patients were divided into 4 groups. Patients of control group (group 1) were treated with equal basic and reperfusional therapy without any cytoprotectors. Patients of the 2nd group received citicholine in dose 1000 mg per day. Patients of the 3rd group were treated with 250 ml actovegin per day. The NIH stroke scale, the modified Rankin scale and the Barthel index were used to assess neurological status dynamics. The significant decrease of neurological deficit and improvement of functional recovery were seen in patients treated both with citicholine and actovegin (p < 0.005) to the 30th day compared to the control group. There was a trend towards the decrease of brain infarction volume within 5 days after stroke in patients of the 4th group. No side-effects of citicholine and actovegin were found.

[Models of neurosurgical service for patients with hemorrhagic stroke].

Authors have conducted an analysis of surgical treatment of patients with hemorrhagic stroke (HS) in Moscow neurosurgical in-patient clinics. In 2 most advanced neurosurgical departments out of 11 studied, only 61% of necessary neurosurgical care is carried out. There are three models of specialized neurosurgical care for patients with HS in large cities. The most effective is a model which comprises a mobile consulting neurosurgical team for selection of patients for surgery and their transport. The causes of insufficient amount of surgical interventions in neurosurgical in-patient clinics are specified. The authors suggest the algorithm of HS patients' selection for surgery.

[Batroxobin in patients with ischemic stroke in the carotid system (the multicenter study)].

A randomized placebo-controlled study has been carried out in 3 Moscow hospitals. A sample included 90 patients who survived hemispheric ischemic stroke caused by pathology in the internal carotid artery 72 h before the treatment. Forty-five patients were given standard (basic) therapy and 45 patients received adjuvant batroxobin intravenously by 1,0 ml (10BU) drops on day 1, 3 and 5 and by 0,5 ml (5BU) drops on day 7 and 9 after admitting in a hospital. Assessment of the patients' state was conducted before the treatment, on day 3, 6 and 15. The European Stroke Scale was used to measure severity of clinical symptoms. The results suggest efficacy of batroxobin the use of which provides rapid good results, especially improvement in movement disorders. The use of this drug is accompanied by defibrinating effect. The drug is well tolerated.

[Involvement of autoimmune mechanisms in development of ischemic brain damage].

Autoimmune processes take place during an acute phase of brain injury as well as during chronic vascular diseases. Cryoglobulinemia is a nonspecific marker of long-term stimulation of the immune system which reflects duration of autoimmune sensitization. It is characterized by production of abnormal temperature-dependent immunoglobulins named cryoglobulins. The highest cryoglobulinemia was found in patients with atherothrombotic stroke that corresponds to the results of previous studies reporting the greatest level of neurospecific antibodies during slow atherothrombosis development. It is shown that cryoglobulinemia is an important factor in pathogenesis of stroke which contributes to microcirculatory and hemorheological disorders, increases blood viscosity and results in the development of immunocomplex endovasculitis of small brain blood vessels in the ischemic lesion.

[The influence of hormones of stress-promoting system on the course of acute ischemic stroke]. / Vliianie gormonov stressrealizuiushchei sistemy na techenie ostrogo perioda ishemicheskogo insul'ta.

Experimental and clinical studies have proved an important role of the reaction of a stress-realizing endocrine system for both a course and an outcome of acute somatic diseases. That is why plasma concentrations of thyroxine (T4), triiodo-thyronine (T3), thyrotropic (TTH) and adrenocorticotropic (ACTH) hormones as well as of renin were measured during the 1-st week of acute ischemic stroke (AIS) in relevant patients for determination of their prognostic significance. 16 patients with hemispheric AIS were examined. A complex clinical biochemical investigation performed in patients with acute disorders of cerebral circulation revealed the presence of the "low T3 syndrome" accompanied by an increase of blood plasma levels of T4 by the 7-th day of the disease as well as an increase of the concentrations of TTH, ACTH and renin on the 2-nd day of the stroke. That reflected the severity of cerebral ischemia. Close correlation observed between the degree of normalization of hormonal concentrations and manifestations of neurologic disorders' regression by the 7-th and the 21-st days gave a good ground to consider these indices as a prognostic criterion for determination of an outcome of the acute period of ischemic stroke.

[Proteinuria in diabetics before and after treatment with the Biostator apparatus]. / Issledovanie proteinurii u bol'nykh sakharnym diabetom do i posle lecehniia s pomoshch'iu apparata "Biostator".

The authors present for the first time their results concerned with the determination of selective proteinurea by disc electrophoresis in polyacrylamide gel in patients with insulin-dependent and insulin-independent diabetes mellitus with and without the clinical signs of kidney affection. A study was made of the uroproteinograms of these patients before and after the correction of carbohydrate metabolism by means of programmed insulin administration. A conclusion was made of a possibility to use the above method for early detection of diabetic nephropathies. Programmed insulin administration using the Biostator apparatus was shown to improve tubuloglomerular functions, that was expressed in the lowering of proteinurea and in some cases in the improving of the qualitative composition of uroproteins.