Objective: to evaluate the results of managing patients with subarachnoid hemorrhage in the Krasnoyarsk Region using the Regional Stroke Monitoring (RSM) module for the period 2014-2020. Material and methods. We analyzed 836 electronic applications from regional hospitals of the region in the RSM module for patients with subarachnoid hemorrhage for the period 2014-2020. Results. Over the seven-year period of work in the RSM module (2014-2020) it was possible to increase the number of patients with ruptured cerebral aneurysms transferred from the regions for surgery by 52.2% (from 88 patients in 2014 to 134 in 2020) and reduce the time from the admission of patients with subarachnoid hemorrhage to the regional medical institutions to their transfer to the regional vascular center for 1 day (from 1,5±0,6 days in 2014 to 0,6±0,5 days in 2020). Conclusion. In the geographically long Krasnoyarsk Region, where it is impossible to perform neurosurgical operations in most district hospitals, RSM module helps to track patients with aneurysm ruptures in real time and transfer them to the regional vascular center for surgical treatment in a timely manner, before the re-rupture or development of angiospasm.

The article presents an overview of modern scientific publications on echinococcosis and alveococcosis of the brain, which occur in 1–4 % of cases among all volumetric formations of the central nervous system. Despite the fact that these parasitic diseases are more common in endemic areas of developing countries in Asia, South America, Australia and New Zealand, isolated clinical cases are observed everywhere, including due to population migration, and they must bedifferentiated, first of all, from intracerebral cysts, abscesses, cystic tumors. Clinical manifestations of echinococcosis and alveococcosis of the brain include the development of hypertensive symptoms, focal neurological deficit, convulsive syndrome (with cortical localization of cysts). The article presents the modern possibilities of diagnostic methods (among which the main role is played by neuroimaging methods, such as multislice computed tomography and magnetic resonance imaging using contrast/paramagnet), and surgical and medical treatment of patients with echinococcosis and alveococcosis of the brain. The article also describes two own clinical observations of patients who were hospitalized in the neurosurgical department of the Regional Clinical Hospital (Krasnoyarsk).

ель. Улучшение результатов лучевой диагностики постнекротических кист поджелудочной железы. Материалы и методы. В исследование включено 129 пациентов с диагнозом: «Киста поджелудочной железы» (34%-женщин, 65%-мужчин). Всем была выполнена МСКТ брюшной полости с контрастным усилением. 26 пациентам проведена чрескожная цистография, 29-эндоскопическая цистография, 14-эндоскопическая ретроградная панкреатография (контрастный препарат «Тразограф»). В ходе исследования проводилась дифференциальная диагностика кистозных образований поджелудочной железы, определялись зрелость стенки псевдокисты, инфицированность содержимого и наличие разгерметизации вирсунгова протока. Результаты и обсуждение. По результатам МСКТ кистозные опухоли поджелудочной железы выявлены у 17% пациентов (данная группа в исследование не включалась), у 19% диагностирована несформированная постнекротическая киста, у 81% стенка псевдокисты была сформирована; 25% кист-инфицированы, 75%-стерильны. По результатам чрескожной цистографии, эндоскопической цистографии, эндоскопической панкреатографии разгерметизация главного панкреатического протока выявлена у 27%, 31% и 43% соответственно. Выводы. Чувствительность лучевых методов исследования в диагностике постнекротических кист поджелудочной железы (ПКПЖ) высока и находится в пределах 95-100%. Ключевые слова: киста поджелудочной железы, острый панкреатит, панкреонекроз, постнекротическая киста, псевдокиста.

The problem of diagnosing postnecrotic cysts of the pancreas is considered in this article. The characteristics of laboratory (determination of the level of amylase, cytological research of punctate, determination of tumor markers) and radiation (ultrasound, endosonography, RCP, MSCT, etc.) methods of research of this pathology are presented, their specificity in the differential diagnosis of cystic formations, depressurization of the main pancreatic duct and formation of the cyst wall is considered. We concluded that the use of radiation methods of research significantly improves the diagnosis of pseudocyst of the pancreas and allows to choose a rational treatment tactics and an adequate surgical intervention.

Objective: To assess the frequency of ruptures of very small cerebral aneurysms, features of the perioperative period and outcomes, in comparison with the rupture of ordinarily sized aneurysms.Material and methods: A comparative analysis of the group of patients with ruptured cerebral miliary aneurysms (n = 18) and the group of patients with ruptured cerebral aneurysms of regular size (n = 308) was carried out. All patients underwent open surgery in the first 3 days after the rupture (osteoplastic craniotomy, microsurgical aneurysm clipping). We compared gender, age of patients, severity of the patient’s condition at the moment of admission, severity of subarachnoid hemorrhage, location of aneurysms, aspect ratio, duration of the operation, frequency of intraoperative ruptures, postoperative mortality.Results: It was found that miliary aneurysm rupture occurs in 5.5% of all patients with cerebral aneurysm rupture. The most common cases of rupture of very small aneurysms were in women (77.7%), with a mean age of 50.8 years. Aneurysms of the anterior communicating artery (66.6%) with a narrow neck (average aspect ratio – 2.1) were the most common. Patients with rupture of very small aneurysms were 7.9% more likely to be admitted in a state of subcompensation or decompensation (Hunt-Hess IV–V), they had massive subarachnoid hemorrhage (Fisher III) 19.6% more often than with ruptured aneurysms of regular size. On average, operations in cases of very small aneurysms lasted 30 minutes less than clipping of ordinary aneurysms, but were complicated by intraoperative rupture twice as often (38.8% and 16.5%, respectively). Postoperative mortality in the group of patients with ruptured miliary aneurysms was 5.7% higher than in patients with ruptured aneurysms of regular size.Conclusion: Rupture of cerebral miliary aneurysms is relatively rare. Women of 50–60 years old with very small aneurysms of the anterior communicating artery with a narrow neck constitute the main group of such patients. Massive subarachnoid hemorrhage and severe condition of patients on admission are more common with miliary aneurysms than with ordinarily sized aneurysms. The small size of the aneurysm and the work near the rupture determine the more frequent contact intraoperative rupture when the neck is exposed as compared to operations on larger aneurysms, which negatively affects the treatment outcomes in this group of patients.