[Experience of Regional Vascular Centre in assisting patients with severe cerebrovascular accidents in Novosibirsk]. / Opyt raboty regional'nogo sosudistogo tsentra po okazaniiu pomoshchi bol'nym s ostrym narusheniem mozgovogo krovoobrashcheniia v Novosibirske.

The analysis of the work of the neurological department of the Novosibirsk regional vascular center of City Clinical Hospital #1 for the period from 2013 to 2015 was done. We analyzed the annual reports of the regional vascular center, dynamics of cerebrovascular disease patterns, lethality, about the provision of medical care to patients with stroke, the use of high-tech methods of diagnosis and treatment. Ascertain the progress achieved and the perspectives of further improving the quality of care to patients with stroke due to wider use of methods of rehabilitation in the acute stage of stroke.

Serial human chorionic gonadotrophin determination in the diagnosis of ectopic pregnancy.

Serial human chorionic gonadotrophin (HCG) determinations were made in 21 patients with ectopic pregnancy (EUP) and in 29 patients with early intrauterine pregnancy (IUP) to examine the increase in HCG values. The median slope of the HCG rise for the patients with EUP was 116 IU/1/2 days and 4,220 IU/1/2 days in patients with IUP. The slopes were significantly different (p < 0.05). Using a discrimination limit of 980 IU/1/2 days, the predictive value of a slope below this limit was 90% in EUP compared to the control group of intrauterine pregnancies. Determination of the slope of HCG rise may be of value in early recognition of ectopic pregnancy in patients with increasing HCG levels below the ultrasonographic discriminatory zone. An international agreement on discrimination limits and unity of HCG algorithms is suggested.

Human placental lactogenic hormone as a parameter for placental function in renal transplanted women.

In 13 pregnant women with renal transplants the serum concentration of placental hormones were determined in order to show their ability to predict fetal problems especially placental insufficiency. It is shown that the hPL values were increased because of reduced elimination of hPL, presumably in the renal tubuli. In this study the weight of only one newborn was over the 50th percentile in spite of the fact that all but one had hPL values over the 50th percentile and in even 8 pregnancies the values were over the 95th percentile. In most of the growth-retarded fetus's the ratio between hPL and the weight of the newborns was more complex. It is concluded that in renal transplanted pregnant women, hPL as a parameter for the placental function must be used with reservation and is not able to predict placental insufficiency.

Pregnancy following kidney transplantation.

Following kidney transplantation, 20 women gave birth to 24 infants after the 28th gestational week. All babies were singletons, alive, and free from malformations. The mean weight was 2,595 g (range 1,420-3,200 g) and the mean gestational age was 37.8 weeks (range 32-40 weeks). The cesarean section rate was 75%. On dividing the patients into low- and high-risk groups, the rate of pre-eclampsia, prematurity, and intra-uterine growth retardation was 2-3 times as high in the high-risk as in the low-risk group. No patients experienced graft rejection during the pregnancy but, within 3 months after delivery, two rejection episodes occurred. Later, a further 5 patients experienced graft rejection. All infants developed normally. We conclude that pregnancy following renal transplantation generally has a normal outcome and that the function of the transplanted kidney is unaffected by the pregnancy.

Infections with Neisseria gonorrhoeae and Chlamydia trachomatis in women with acute salpingitis.

The value of cultural and serological procedures in diagnosing gonococcal and chlamydial infections was investigated in 85 women who had provisional diagnoses of pelvic inflammatory disease. The correlation between certain clinical variables and the absence or presence of such infections was also studied. In 46 the diagnosis of acute salpingitis was verified by laparoscopy. The laboratory and clinical findings in the patients with acute salpingitis were compared with those in the remaining 39 women in whom laparoscopy did not show signs of inflammation. Salpingitis was considered to be gonococcal if Neisseria gonorrhoeae was isolated or a fourfold or more change in titre of antibodies to gonococcus pilus antigen was found. The diagnosis of chlamydial salpingitis was based on the isolation of Chlamydia trachomatis, a fourfold or more change in titre of IgG antibodies to or from a titre of greater than or equal to 1/256, or the presence of IgG antibodies at a titre of greater than or equal to 1/512. Patients with chlamydial salpingitis had less severe symptoms but a more protracted course of disease than patients with gonococcal salpingitis or with acute salpingitis not associated with the two pathogens.

Importance of Mycoplasma hominis in acute salpingitis assessed by culture and serological tests.

In 95 women with a provisional diagnosis of pelvic inflammatory disease, a final diagnosis of acute salpingitis was confirmed by laparoscopy in 46 and 10 had strong clinical evidence of acute salpingitis. The findings in the remaining 39 patients without signs of acute salpingitis by laparoscopy were used as a standard of reference. Criteria for the diagnosis of possible mycoplasmal salpingitis were tentatively defined as the isolation of Mycoplasma hominis from the cervix together with positive test results for M hominis antibodies (a titre of greater than or equal to 1/1280 or a change in titre, or both); these criteria were fulfilled in 12 patients with acute salpingitis. A positive correlation between mycoplasmal salpingitis and chlamydial salpingitis or gonococcal salpingitis, or both, was significant. Mycoplasmal salpingitis was not associated with any characteristic clinical feature different from those of patients with non-mycoplasmal salpingitis. Our findings do not support the view that M hominis is an important primary pathogen in acute salpingitis.