[SURGICAL TREATMENT OF PARKINSON'S DISEASE WITH LEVODOPA-INDUCED MOVEMENT DISTURBANCES].

Aim - to evaluate the efficacy of stereotactic pallidotomy and bilateral deep brain stimulation (DBS) of subthalamic nuclei (STN) in patients with Parkinson disease with motor fluctuations and levodopa-induced dyskinesias. 36 patients (age range 31-73 years (mean age 56.2±3.2 years) were enrolled in study. Mean duration of PD was 9.8±1.1years. All patients used levodopa-drugs, mean levodopa dose was 1075±304.1 mg/day. Mean duration of motor fluctuations and levodopa-induced dyskinesias before surgery was 2,18±0,8 years. Patients = were divided into 2 groups - 22 patients underwent stereotactic unilateral pallidotomy and 14 patients underwent bilateral DBS (STN target). Neurological and psychological status assessed before and after treatment by: UPDRS II, Hoehn and Yahr scale, Schwab and England scale, MMSE, Beck's Depression Inventory, Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale and PDQ-39. Surgery performed on CRW stereotactic system. Postoperative follow-upranged from 1 to 8.5 years (mean 4.1±1.1 years). Regression of tremor, rigidity, bradykinesia and levodopa-induced dyskinesia observed in most patients after stereotactic interventions. The best results were achieved in patients who underwent DBS. In this group UPDRS II score improved by 74% in ON period and by 63% in OFF period. After pallidotomy UPDRS II score improved by 55% in ON period and by 47% in OFF period. Levodopa-induced dyskinesia stopped in 21 from 22 (95.5%) patients who had it before surgery after unilateral pallidotomy and in 11 from 12 (91.7%) patients after DBS. Surgical complications occurred in 3 (13.6%) case after pallidotomy, which induced transient neurological deficit. Our results demonstrate that both stereotactic interventions - pallidotomy and DBS are effective and safe methods of treatment of PD with levodopa-induced dyskinesias and motor fluctuations. Both surgeries improve overall motor function, increased patient's mobility and improve quality of life.

[STEREOTACTIC THALAMOTOMY AND CONTRALATERAL SUBTHALAMOTOMY IN TREATMENT OF PARKINSON'S DISEASE].

Aim - to evaluate the efficacy of combined bilateral stereotactic destruction of subcortical nucleus - thalamotomy and contralateral subthalamotomy in patients with Parkinson disease. The study included 10 patients with PD, aged 54-73 (mean age 61.1±5.2 years). The time between two surgeries ranged from 1 to 5 years (mean 2.5±0.5 years). The surgeries were conducted on CRW Radionics stereotactic system using StereoPlan, Atlas (Radionics) andFraimLink (Medtronic) software for target calculating. The neuropsychological status was assessed by UPDRS II, Hoehn and Yahr scale, Schwab and England scale, MMSE. The postoperative follow-up was from 6 months to 5.5 years (mean 3.2±0.9 years). After surgeries tremor stopped or significantly regressed in 9 (90.0%) patients, muscle tone returned to normal in 8 (80.0%) cases and in 7 (70.0%) bradykinesia partially regressed. The increase of motor activity was observed in 8 (80.0%) patients. Levodopa-induced dyskinesia stopped in 5 (50.0%) patients and motor fluctuations regressed in 4 of 5 (80.0%) patients. After the surgery the dose of levodopa decreased on average by 36% - from 885±245 mg/day to 570±165 mg/day. The indices of Schwab and England Activities of daily living improved from 56.1% to 80.7%. The postoperative complications were observed in2 (20.0%) cases. Our results demonstrate that bilateral ablative surgery is an effective and safe method of treatment of PD. Stereotactic radiofrequency thalamotomy and contralateral subthalamotomyimprove overall motor function, increase patient's mobility, allow patients to reduce levodopa dose and improve the quality of life.

[Differentiated approach for determination of the patients treatment tactics in focal affection of brain, using stereotaxic methods].

There were analyzed the results of stereotaxic biopsy in 338 patients, using CRW stereotaxic system (Radionics, U.S.A.), performed with the objective for differential diagnosis and treatment conduction in the focal affection of brain (of tumoral and nontumoral etiology). In the recurrent cystic affection of brain there were determined diagnostic informativity and trustworthiness of the cysts stereotaxic aspirationance, the abscesses drainage and the Ommaya reservoir implantation. There was proved the important significance of stereotaxic methods in differential diagnosis and treatment of the brain focal affection.

Impact of an intravenous fluconazole restriction policy on patient outcomes.

OBJECTIVE: To evaluate both the economic and clinical impact of an intravenous fluconazole restriction policy in a university teaching hospital. METHODS: Intravenous fluconazole was restricted to patients unable to take oral medications due to significant nausea or to patients whose oral intake was restricted. A retrospective chart review and computerized record review was conducted in patients receiving intravenous or oral fluconazole from January 1 to June 30, 1997, and again from January 1 to June 30, 1998, after implementation of the policy. RESULTS: Six-month institutional expenditures for intravenous fluconazole decreased following policy implementation, from $81,900 to $45,400, an estimated annual institutional savings of $73,000. A 47% reduction in the number of patients treated with intravenous fluconazole was observed over the six-month period after policy implementation. During this time, the rate of successful clinical outcomes for documented or suspected disseminated Candida albicans infection or febrile neutropenia remained the same (66.6% prepolicy and 65.9% postpolicy; p = 0.95). Similarly, the number of deaths in patients receiving fluconazole remained unchanged (p = 0.31). CONCLUSIONS: A restriction policy for intravenous fluconazole results in significant cost savings, with no significant decrease in successful outcomes or change in mortality.

[Content of vasopressin and beta2-microglobulin in the blood in patients with diabetes mellitus type II accompanied by microangiopathy]. / Soderzhanie vazopressina i beta2-mikroglobulina v krovi bol'nykh sakharnym diabetom II tipa s nalichiem mikroangiopatii.

Altogether 50 patients with diabetes mellitus, type II, with the presence of microangiopathies and 10 healthy controls were investigated to study the pathogenesis of vascular complications. An increased level of vasopressin and a normal level of beta 2-microglobulin were radioassayed in the blood plasma of the examinees. An acute furosemide test made it possible to establish 3 types of responses of vasopressin secretion in such patients: normal, paradoxical and areactive. The blood level of beta 2-microglobulin was raised in 65% of cases in the paradoxical response, in 34.5% in the normal response and in 0.6% in the areactive response. The data obtained suggested heterogeneity of the mechanisms of development of vascular complications in diabetes mellitus, type II.