[Actovegin in the treatment of brain injuries of mild and moderate severity].

Sixty-eight patients, including 32 patients of the main group who received aktovegin in addition to standard therapy and 36 patients of the control group with standard therapy only, have been studied. In both groups, various traumatic injuries (small focal injuries, subdural and epidural hematomas, traumatic subarachnoid hemorrhages, a combination of covering hematoma and small focal injuries) have been found. Aktovegin has been used in drops in dosage 400 mg per 200 ml physiological solution for 10 days. A comparative analysis of clinical data and results of instrumental studies (EEG, CT etc) in the main and control groups gives grounds to conclude that the use of aktovegin in the complex with standard therapy improves the course of brain injuries thus promoting the earlier compensation of disturbed functions and shortening the terms of treatment. The regress of asthenic symptoms as well as positive EEG changes are most pronounced.

[Difficulties in forensic medical evaluation of some forms of craniocerebral injury]. / Trudnosti v sudebno-meditsinskoi otsenke nekotorykh form cherepno-mozgovoi travmy.

Conclusions of 41 repeated expert evaluations of craniocerebral injuries within the framework of criminal and civil cases investigation are analyzed. Some aspects of clinical and forensic medical diagnosis of lethal and nonlethal injuries to the head, evaluation of the quality of medical care, and qualification of the severity of harm to health are discussed. Causes of typical expert errors and approaches to their prevention are shown.

[The surgical treatment of traumatic brain lesions located sub- and supratentorially]. / Khirurgicheskoe lechenie travmaticheskogo povrezhdeniia mozga sub- i supratentorial'noi lokalizatsii.

The article describes two patients with a rarely encountered pathological condition--traumatic damage to the brain of sub- and supratentorial localization. Timely diagnosis and early surgical treatment of multiple injuries to the cerebral hemispheres and posterior cranial fossa became possible with the introduction of brain computed tomography into clinical practice.

[The diagnosis and method of surgical treatment in dislocation of the brain under the falx cerebri in craniocerebral trauma]. / Diagnostika i metodika khirurgicheskogo lecheniia dislokatsii golovnogo mozga pod bol'shoi serpovidnyi otrostok pri cherepno-mozgovoi travme.

In 6.6% of cases a severe craniocerebral trauma is accompanied with dislocation of the brain under the falx cerebri with incarceration of the cingulate gyrus. The diagnosis of dislocation under the falx in intracranial traumatic hematoma and brain contusion-crushing is discussed. Falxotomy may be among the methods for the prevention or correction of incarceration of the cingulate gyrus. The authors suggest an operative approach for performing falxotomy with little injury as well as a surgical instrument for one-stage clipping of the inferior sagittal sinus and its division.

[Ultrasonic method of studying intracranial blood and cerebrospinal fluid dynamics in healthy subjects and in pathology]. / Ul'trazvukovoi metod issledovaniia vnutricherepnoi gemolikvorodinamiki v norme i patologii.

A noninvasive ultrasonic method of brain biolocation with the sensor positioned in the region of the frontal eminences, was developed. The selected signal from an immobile structure, the occipital bone, is registered graphically. The method allows the cerebral hemispheres to be studied separately, yields information which is more precise than that obtained by means of the commonly known methodical approaches, and provides data on the intracranial dynamics of blood and cerebrospinal fluid. The results of the study provide evidence of a statistically significant (P less than 0.05) shift in the index of ultrasonics pulsed fading (alpha p) in healthy individuals and in patients with cerebral lesions and changes in the functional and neurological state. To verify the noninvasive methods parallel studies were conducted by means of the invasive method.

[Effect of hyperbaric oxygenation on respiration in acute cerebral circulatory disorders]. / Vliianie giperbaricheskoi oksigenatsii na funktsiiu vneshnego dykhaniia pri ostrykh narusheniiakh mozgovogo krovoobrashcheniia.

The OKA-MT pressure chambers were used. External respiration was studied by spirography by means of the SG-2M spirograph. From the results of examination of 53 patients with acute cerebral circulatory disorders it was established that hyperbaric oxygen normalizes the initially abnormal external respiration: corrects the periodical rhythms and reduces hyperventilation; the hyperbaric oxygenation sessions have no effect on initially normal respiration; the reaction of external respiration to hyperbaric oxygen changes during the course of treatment depending on the number of sessions; the appearance or intensification of the hyperventilation syndrome after one or three hyperbaric oxygenation sessions in the absence of negative neurological dynamics cannot be assessed as a contraindication for hyperbarotherapy.

[Potentials of hyperbaric oxygenation in correcting central respiratory disorders in ischemic stroke]. / Vozmozhnosti giperbaricheskoi oksigenatsii v korrektsii tsentral'nykh narushenii dykhaniia pri ishemicheskom insullte.

Changes in central respiratory disorders under the effect of hyperbaric oxygenation (HBO) were studied in 29 patients in the acute stage of ischemic stroke. Spirography, tetrapolar rheography, and examination of the blood gas composition were carried out. Before HBO was begun, various disorders of the respiratory function were found (hyperventilation syndrome, periodical rhythms: Cheyne-Stokes respiration, alternating respiration, etc.). It was revealed that HBO session causes a normalizing effect on the respiratory function in central disorders of respiration: the Cheyne-Stokes rhythm was replaced at the end of the session by wave-like respiration which is biologically more adequate, the regimen of hyperventilation changed to normoventilation, etc. There was parallel improvement in the indices of central hemodynamics and the blood gas composition.

[Effect of dehydration therapy on intracranial pressure and local cerebral blood flow in hemorrhagic stroke and cranio-cerebral injuries]. / Vliianie degidratsionnoi terapii na vnutrimozgovoe davlenie i lokal'noi mozgovoi krovotok pri gemorragicheskom insul'te i cherepno-mozgovoi travme.

The degree and duration of the effect of dehydration therapy on intracerebral pressure and local cerebral blood flow were studied. The record was taken by means of an original combined sensor implanted into the brain tissue during neurosurgical operations in patients with acute disorder of cerebral circulation of the hemorrhagic type and severe craniocerebral trauma. Urea, mannitol, and glucose were applied as the dehydration agents. They were infused intravenously with due account for the initial values of intracerebral and arterial pressure.

[Surgical treatment of ischemic strokes]. / O khirurgicheskom lechenii ishemicheskikh insul'tov.

The following operations were performed for ischemic strokes in 116 patients: resection of a loop of the internal carotid artery on the neck, resection of the sympathetic ganglion, and the creation of anastomosis between the branch of the superficial temporal artery and the cortical branch of the middle cerebral artery. The method of the microsurgical intervention is described in detail and the indications and contraindications for various operations in ischemic strokes are discussed. Elaboration and improvement of the methods of microsurgery will make it possible to map out the prospects in the treatment of cerebral circulatory disorders.

[Repeated intracranial hemorrhages, their prevention and treatment]. / Povtornye vnutricherepnye krovoizliianiia, ikh profilaktika i lechenie.

The formation of recurrent hematomas was encountered in patients operated on for intracranial hematomas of traumatic and nontraumatic origin and for contusion of the brain. To prevent recurrent hemorrhages, the authors employed active aspiration of the wound canal contents by means of a three-jar aspirator or a microaspirator in the postoperatice period in 56 cases. It is noted that active aspiration of the wound discharge, continued for 2--4 days, makes it possible to avoid the formation of recurrent intracranial hematoma and to reduce resorption of the decomposition products, this improves the course of the postoperative period.

[Cranio-cerebral hypothermia in the treatment of patients with cranio-cerebral injuries]. / Kranio-tserebral'naia gipotermiia pri lechenii bol'nykh s cherepno-mozgovoi travmoi

Within a set of therapeutic measures the authors employed cranio-cerebral hypthermia with the aid of an air hypotherm in 56 patients with severe skull-brain trauma. The temperature of the convexital cortex was reduced in the majority of cases to 28-30 degrees C, the rectal temperature being preserved at 33-34 degrees C. It was found that craniocerebral hypothermia should be employed in skull-brain injury patients as soon as the presence of a space-occupying intracranial formation requiring a surgical intervention is excluded, or immediately thereafter. The reduction of cerebral metabolism during the colling can be indirectly demonstrated by EEG changes and evoked potentials recordings.