Short-term and long-term cognitive function and cerebral perfusion in off-pump and on-pump coronary artery bypass patients.

OBJECTIVE: The aim of this study was to evaluate cognitive function, as measured by serial neuropsychological testing, and cerebral perfusion, as measured by brain SPECT scanning in patients with coronary artery diseases (CAD) following off-pump and on-pump coronary artery bypass graft surgery. Besides, the relationship between cerebral blood flow, cognitive functions, surgery parameters, and cardiac function in these patients were estimated. Also, brain-protective effects of instenon were studied. METHODS: Brain SPECT and comprehensive neuropsychological testing were performed 1 day before, 10-14 days and 6 months after coronary artery bypass graft surgery (CABG). The study involved 65 patients (62 males and 3 females, mean age 55+/-2) who underwent CABG with cardiopulmonary bypass (CPB) (43 pts) and off-pump coronary revascularization (OPCAB) using the Octopus stabilization system (22 pts). In 21 cases employing CPB, for prevention of the impairments of cerebral perfusion and cognitive deficit instenon was administered. RESULTS: CABG with the use of extracorporeal circulation is complicated by short-term and long-term neurocognitive dysfunction (in 96 and 55% cases, correspondingly). Also, in the early period after CABG, in 68% patients, decrease in regional cerebral blood flow (rCBF) was found, and after 6 months brain perfusion was lower than the baseline in 55% cases. Relationship between postoperative rCBF changes and the dynamics of cognitive function was found in early period and after 6 months following CABG. CONCLUSION: The coronary revascularization on beating heart or preventive administration of instenon in CPB patients helps significantly to diminish the risk of cerebrovascular complication.

[Pharmacological prevention of cerebrovascular complications in cardiac patients after coronary artery bypass surgery]. / Medikamentoznaia profilaktika tserebrovasculiarnykh oslozhnenii u bol'nykh ishemicheskoi bolezn'iu serdtsa posle aortokoronarnogo shuntirovaniia.

The aim of the study was to evaluate cognitive functions and cerebral perfusion in cardiac patients following coronary artery bypass graft surgery (CABG) and to investigate a potential of pharmacological prevention of neurocognitive deficit and cerebral perfusion disorders. Forty patients undergone CABG with cardiopulmonary bypass (CPB) were included in the study. For prevention of cerebral perfusion impairments and cognitive deficit, instenon ("Nycomed") was administered to 18 of the patients. The results revealed that the use of instenon allowed reducing a negative effect of CABG with CPB on neuropsychological state of the patients, thus preventing cerebral perfusion disturbances during surgery intervention.

[Use of instenon in complex treatment of patients with optic nerve atrophy caused by craniocerebral trauma]. / Primenenie instenona v kompleksnom lechenii patsientov s atrofiei zritel'nogo nerva vsledstvie cherepno-mozgovoi travmy.

Instenon, a combined nootropic agent, was used on the step-type basis within a complex treatment of optic nerve atrophy caused by craniocerebral trauma. Our study revealed that instenon, when used within a complex treatment of a partial optic nerve atrophy caused by craniocerebral trauma, improved the visual acuity in 85.7% of patients and it expanded the total visual field in 76.2% of patients, whereas the routine therapy ensured the related improvements in 58.9% and 61.5% of patients, respectively. Besides, the drug provided for a better retinal electric sensitivity and for a better optic nerve conduction in 73.8% of cases versus 64.1% of cases with basic therapy. Increased velocity parameters in the ocular-artery blood flow were registered in 77.1%, of patients who received instenon, by duplex scanning.

[The use of instenon in children with minimal brain dysfunction]. / Primenenie instenona pri lechenii minimal'noi mozgovoi disfunktsii u detei.

Minimal brain dysfunction (MBD) represents the most common type of neuropsychic disorders in childhood. Resulting in focal damages, underdevelopment and dysfunction of one or another cortical regions of brain hemispheres, MBD manifested in children as movement and speech disorders, dysgraphy, dyslexia, dyscalculia and attention deficit hyperactivity disorder. In the open controlled study, an efficacy of the complex nootropic medication "Instenon" was evaluated in the treatment of 59 MBD patients, aged 4-12 years. Control group included 27 children with MBD assigned to low polyvitamin (Sana Sol) doses. The treatment duration was 1 month. Before and after treatment, children with MBD underwent complex examination, which included parent's interviewing using structured questionnaire, general examination, with detailed analysis of complaints, neurological status investigation and psychological study. In the children taken instenon, distinct positive effect has been achieved in 71% of the cases, in control group--in 15%. Positive effect emerged in improvement of behavior characteristics, better school marks, movement, attention and memory indices, functions of psychic activity, organization, programming and control. When strictly keeping a scheme prescribed (gradual dose increase, drug taking in morning and day time), a risk for unfavorable side effects is minimal.

[Instenon in the treatment of acute disorders of the cerebral circulation]. / Instenon v lechenii ostrykh narushenii mozgovogo krovoobrashcheniia.

Effectiveness of Instenon (Alkaloid Pharm. Co.), the preparation, containing hexobendin, hydroxytheophyllin, etamivan was investigated in treatment of patients with acute cerebrovascular disorders. Instenon was applied in acute phase of ischemic stroke both in form of ampules and dragee as well as for intravenous injections too. Marked positive influence of Instenon was observed on motor, sensory, autonomic and psychic functions. Instenon in form of ampules had advantage compared to dragee form in terms of faster positive alterations onset. Application of Instenon in form of ampules was more effective in patients with disorders of consciousness while usage of drug in the form of dragee was more effective in patients with cerebrovascular disorders in vertebro-basilar system. The drug hadn't significant influence on systemic arterial pressure either after single injection or long-termed treatment; the mild hypotensive effect was observed after therapeutical session. The drug was well tolerated by patients in both forms and hadn't any side effects. There were no negative consequences of Instenon interaction with other preparations. The conclusion was made about possibility of application of Instenon for the treatment of ischemic stroke.

[Changes in the parameter of asymmetry of EEG wave fronts in patients with cerebral circulatory disorders treated with instenon]. / Izmenenie parametra asimmetrii frontov voln EEG u bol'nykh s narusheniiami mozgovogo krovoobrashcheniia pri lechenii instenonom

The distribution of the parameter of asymmetry of the wave fronts in EEG on the convexital surface of the cortex during instenon administration is significantly changed in time and becomes normal after 3 hours of observation. This may point to an improvement of the functional state of the brain under the influence of the drug. The most distinct positive dynamics in such conditions were marked in patients with general brain symptoms and transient disorders in the vertebro-basillar system. A transition of desynchronized EEG to hypersynchronized with a subsequent normalization of the structure is apparently conditioned by the central influence of the preparation on the synchronizing areas of the brain reticular formation.