[Clinical and electrophysiological and molecular genetic characteristics of the course of relapsing-remitting multiple sclerosis].

In order to study specific features of remitting multiple sclerosis patients with different genotypes of polymorphic loci rs1800629 gene TNFα, rs6074022 gene CD40, rs10492972 gene KIF1B, rs187238 IL-18 gene, conducted clinical and electrophysiological examination of 149 patients with relapsing-remitting multiple sclerosis. Found that the most common symptoms of rapidly progressive relapsing-remitting multiple sclerosis were cerebellar and sensory disorders. Severity of pyramidal and cerebellar, stem, pelvic disorders, and thus the value of EDSS score was significantly higher in the group of patients with recurrent exacerbations during the year. Intensity changes of latencies of peaks I, III of short-stem evoked potentials and central motor conduction time determined by the ball on a scale EDSS. Genotype C/C polymorphism rs187238 locus IL-18 gene associated with frequent exacerbations of relapsing-remitting multiple sclerosis, high speed of progression of the disease and is characterized by marked changes in latency of peak V ABR and VEP P100. With polymorphic locus allele rs187238 IL-18 is associated with more frequent exacerbations PPC (OR=1.714 (1.051-2.797); p=0.02), and increases the risk of rapidly progressive nature of the disease in a 2-fold (OR=2.040 (1.140-3.650) p=0.015).

[A combined method to protect the brain during operations on the brachiocephalic arteries].

Based on the outcomes of surgical management of thirty-six patients diagnosed with atherosclerosis of carotid arteries and a further thirty-five 35 patients presenting with atherosclerotic lesions of the subclavian and vertebral arteries the authors substantiated a differentiated therapeutic policy aimed at protecting the brain from ischaemia, having demonstrated efficiency of cerebral protection with nimodipine and rheopolyglukin in patients subjected to operations on the subclavian and vertebral arteries and feasibility of combining this method with the application of a temporary puncture carotid-artery bypass graft during carotid endarterectomy. Functional possibilities of puncture-mediated bypass grafting of the carotid artery was confirmed by studying the blood flow in the common, internal carotid and median cerebral arteries on the operated side and ipsilateral side in patients with and without a bypass graft applied.

[Remote results of surgical treatment management for atherosclerotic lesions of the brachiocephalic trunk].

AIM: Optimization of diagnosis and surgical treatment of lesions of the brachiocephalic trunk (BCT) based on analysing the course of cerebrovascular disease in operated and nonoperated patients presenting with atherosclerotic lesions of the BCT. MATERIALS AND METHODS: During the period form 1992 to 2008, we followed up a total of sixty-three patients presenting with atherosclerotic lesions of the BCT, who were subdivided into two subgroups: Subgroup One ("surgical") was composed of the patients subjected to reconstructive operations on the BCT (n =25), and Subgroup Two ("therapeutic") comprised nonoperated patients (n =38). RESULTS: Patients from Subgroup One underwent a total of 25 operations: twelve patients endured intrathoracic reconstruction with linear prosthetic repair of the BCT and the remaining thirteen sustained balloon-mediated dilatation of the BCT. Intraoperative restoration of the BCT's patency was achieved with all interventions. The reoentgenoendovascular operations were accompanied with no complication. In 2 cases (16.7%) prosthetic repair of the BCT was followed by thrombotic complications (1--thrombosis of the BCT and 1 thrombosis of the stenosed ipsilateral vertebral artery) in the early postoperative period. During the follow-up period, patients of the surgical subgroup developed 3 strokes (12.0%), 3 myocardial infarctions (12. 0%) and 1 sudden death (4.0%). Over the 5-year period, patients with the BCT le-sions resulting from the natural course of cerebrovascular disease developed 14 ischaemic strokes (31.6% (chi 2=26.4, p<0.0001), 5 (13.2%) myocardial infarctions (chi 2 =0.14, p =0.712), and 2 (5.3%) cases of sudden death. The relative risk of stroke in the therapeutic subgroup amounted to 32.6%. A decrease in the absolute risk of ischaemic stroke resulting from reconstruction of the BCT amounted to 24.8%. Hence, in order to prevent one stroke it is necessary to operate on four patients presenting with BCT lesions. CONCLUSION: Reconstructive operations on the BCT are efficient in relation to prevention of ischaemic strokes. However, intrathoracic reconstructions were accompanied andfollowed by a relatively high level o fcomplications. Therefore, it is necessary to use noninvasive methods of diagnosis to reveal patients presenting with BCT lesions at the stage of moderate stenoses and to subject them to preventive operation of balloon-mediated angioplasty.

[Vertebrogenic and atherosclerotic mechanisms of vertebral basilar insufficiency: comparative ultrasonic characteristics].

Using a complex of ultrasonic methods, vertebral basilar system hemodynamics has been evaluated in normal state and in case of vertebral basilar insufficiency (VBI). The differential diagnostic criteria of atherosclerotic and vertebrogenic types of VBI development have been obtained that enables to individualize the therapeutic approaches.