Mortality and disability rates in spontaneous intracranial hemorrhages remain high despite medical advances. In recent decades, much attention has been paid to neuroinflammation as a typical response to brain damage. Inflammation plays an important role in the acute and chronic phases of the disease. The relationship between plasma and cerebrospinal fluid cytokines, as well as the factors affecting their ratios, is currently not completely clear.The objective was to study the inflammatory response to spontaneous intracranial hemorrhage.Subjects and Methods. 59 patients aged 18 to 72 years (48 ± 6) were enrolled in the study. Patients were admitted to the intensive care unit after an episode of spontaneous intracranial hemorrhage. The levels of interleukins in blood plasma were studied: 6, 8, 10, TNF-α, C-reactive protein,blood leukocytes, and procalcitonin (by a semi-quantitative method). In the cerebrospinal fluid, the following parameters were evaluated: cytosis, protein, glucose, lactate, cytokines (6, 8, 10, TNF-α). Blood samples were collected on days 1, 2, 3, 5, 7, 9, 14, 21, 28, 35, and 45.Results. Systemic inflammatory response developed in all patients from the first day of acute brain injury. The most significant response was formed by glial brain cells which was confirmed by high levels of cytokines in the cerebrospinal fluid, hundreds and thousands of times higher than blood levels of cytokines.Conclusion. Levels of pro-inflammatory cytokines are predictors of an unfavorable outcome.
ОБЗОРЫ «Вестник хирургии» • 2018 76В ургентной хирургии особое место занимают острые крово течения из верхних отделов желудочно-кишечного тракта (ЖКТ) [1]. Это обусловлено тем, что они являются осложне-нием различных заболеваний, а именно -сепсиса, пневмонии, острой почечной и(или) печеночной недостаточности, при раз-личной патологии сердечно-сосудистой и центральной нерв-ной систем (ЦНС) и др. [2]. Наиболее актуальной проблемой при ургентной патологии ЦНС являются их осложнения, в частности, гастродуоденальные кровотечения, которые по свое-му происхождению и механизму развития отличаются друг от друга. Наличие желудочно-кишечных кровотечений (ЖКК) у больных с острыми заболеваниями ЦНС значимо ухудшает состояние больного, увеличивает сроки нахождения в стацио-наре, реабилитации и может приводить к летальному исходу.Сосудистые заболевания завоевывают первое место (40-50 %) в структуре патологии ЦНС [3], среди которых особую роль играет острое нарушение мозгового кровообращения (ОНМК). В мире каждый год диагностируется 17 млн новых случаев ОНМК [4]. За последние 10 лет в России отмечается рост заболеваемости инсультом на 30 %, составляя 3,36 боль-ного на 1000 населения в год [5]. На сегодняшний день смерт-ность от ОНМК остается высокой во всем мире. По данным авторов, в России смертность от ОНМК составляет 175 человек на 100 000 населения в год [3]. В Великобритании ежегодно регистрируется более 9000 смертей от этого заболеваний, 36 % из которых имели кровотечение из острых язв верхних отделов ЖКТ [6]. При анализе 11 проспективных клинических иссле-дований кровотечения из острых язв ЖКТ были выявлены с частотой от 19 до 54 больных на 100 000 населения, страда-ющих ургентной неврологической патологией [4]. Одним из грозных осложнений больных с критическими заболеваниями ЦНС являются кровотечения из острых повреждений слизи-стой ЖКТ.Частота возникновения гастродуоденальных кровотече-ний у этой категории пациентов недостаточно исследована, име ющиеся литературные сведения противоречивы. При ретроспективном изучении 16 612 больных ОНМК в клинике «Маyo» с 1976 по 1994 г. было выявлено 17 больных с крово-течением из ЖКТ [2]. У 14 из 17 пациентов были отмечены два острых состояния, а именно -ишемический инсульт и гастродуоденальное кровотечение. У остальных 3 больных гастродуоденальное кровотечение сочеталось с геморрагиче-ским инсультом и субдуральной гематомой. При проведении эндоскопического исследования у этих больных выявлены изменения в ЖКТ в виде гастроэзофагеальной эрозии, гемор-рагического гастрита и язвы желудка. Авторы, изучая патоге-нез развития данной патологии, пришли к выводу, что у 16 из 17 пациентов кровотечения связаны с приемом нестероидных противовоспалительных препаратов, антикоагулянтов и кор-тикостероидных лекарств. У остальных 2 больных выявлена инфицированность Helicobacter pylori. В заключении авторы указывают низкую сочетаемость инсульта и гастродуоденаль-ного кровотечения -0,1 %. В то же время, по данным других исследователей, кровотечения из верхних отделов ЖКТ у пациентов, страдающих ишемиче...
Nowadays medicine needs high information technologies. Automation of the processes of diagnosis, stratification and treatment of diseases belongs to the priority tasks in modern medicine, since it allows increasing the efficiency and reliability of working with information, data accuracy and completeness at all stages of the medical process. Smart ward is an integral approach to automation of this process. This paper proposes an approach to creating a module for diagnosing, stratifying and selecting treatment of the paroxysmal sympathetic hyperactivity syndrome and highlights the advantages of using this module as an intelligent component of the smart ward. A data model defining medical data for this particular task is built and described using UML class diagrams. It can be seen that the model entities and their properties partially correspond to the entities and properties in the smart ward model, which allows linking local and global databases and provide higher completeness and reliability of patient information, which, in turn, will increase the efficiency of the system in general. Further research includes building a behavioral model of a smart ward and defining the scenarios of its operation, taking into account specific tasks, such as identifying paroxysmal sympathetic hyperactivity or other syndromes, determining the set of ward components necessary for the implementation of these processes, and choosing protocols for their interaction.
Paroxysmal sympathetic hyperactivity (PSH) is one of the complications of acute severe brain injuries (traumatic brain injury, intracranial hemorrhage, ischemia, and posthypoxic conditions) in both adults and children. Its high incidence and severe sequelae including organ dysfunction, infectious complications, impaired blood supply to organs and tissues associate with increased disability and mortality. The choice of effective therapy can be challenging because of multifaceted manifestations, diagnostic difficulties, and lack of a clear understanding of the pathophysiology of PSH. Currently, there are various local and international treatment strategies for PSH.The aim of the review is to summarize clinical and scientific research data on diagnosis and treatment of PSH to aid in the selection of an effective therapy.Material and methods. Web of Science, Scopus and RSCI databases were employed to select 80 sources containing relevant clinical and research data on the subject of this review.Results. The key principles of diagnosis and treatment of paroxysmal sympathetic hyperactivity have been reviewed. The current views on etiology and pathogenesis of paroxysmal sympathetic hyperactivity development were outlined. The clinical data concerning complications and sequelae of paroxysmal sympathetic hyperactivity were analyzed. We conclude the review with a discussion of current methods of the syndrome prevention.Conclusion. Preventing PSH and its adequate and prompt treatment could help avoid the abnormal pathway development following a severe brain injury, reduce its negative consequences and rate of complications, along with the duration of mechanical lung ventilation, patient's stay in ICU, disability and mortality rates. Careful selection of pathogenetic, symptomatic and supportive therapy significantly improves the rehabilitation potential of patients.
INTRODUCTION. Gastroduodenal bleedings often occurs among patients with cerebrovascular accident (CVA). The frequency, causes and treatment tactics for bleeding from the upper gastrointestinal tract (GIT) in this group of patients have not been sufficiently studied. There were no well established guidelines of treatment for this group of patients, that could be a reason for high mortality. The OBJECTIVE of the study was to improve the treatment outcome of gastroduodenal bleeding cases in patients with cerebrovascular accident (CVA) by using conservative and endoscopic methods that could be used to stop bleeding and developing tactics of treatment in this category of patients. MATERIAL AND METHODS. There were 105 patients with cerebrovascular accident (CVA) and signs of bleeding from the upper gastrointestinal tract in the study. Patients were admitted to the St. Petersburg City Mariinsky Hospital from 2013 to 2018 years. Patients were divided into 2 groups, regarding the type of cerebrovascular accident (CVA): patients with ischemic stroke and patients with hemorrhagic stroke. All patients underwent esophagogastroduodenoscopy (EGD) during 2 hours from identifying the signs of bleeding. RESULTS. In this study, we analyzed medical files and records of patients with diagnosis of ischemic or hemorrhagic stroke, who were admitted to St. Petersburg City Mariinsky Hospital from 2013 to 2018 years. During the observation of patients with diagnosis of ischemic or hemorrhagic stroke, 7483 patients and 1919 patients respectively were treated in the clinic. Among these patients, 58 patients were with diagnosis of acute stroke with ischemic type and 47 patients with acute hemorrhagic stroke in combination with bleeding from upper parts of a GIT. The frequency of the upper GI bleeding was 0.77 % (58 of 7483) in the group with ischemic type of stroke; in the group of patients with hemorrhagic stroke, gastroduodenal bleeding was diagnosed in 2.45 % (47 of 1919) cases. CONCLUSIONS. Endoscopic treatment of gastroduodenal bleeding in cases of ischemic and hemorrhagic stroke was the method of choice. The combined endoscopic hemostasis method was preferred. To achieve hemostasis in cases of superficial lesions of the mucous membrane of the upper gastrointestinal tract and acute ulcers of the gastroduodenal zone in combination with CVA, Argon plasma coagulation (APC) was effective. It was possible to combine APC with other methods of endoscopic hemostasis that improved the results of treatment and reduced the risk of recurrent bleeding. If bleeding was from chronic ulcers of the stomach and / or duodenum, the method of clipping was effective in combination with APC and / or with injection method. When signs of recurrence of bleeding appeared, all patients with CVA should have undergone esophagogastroduodenoscopy (EGD) and hemostasis by endoscopic methods. All patients with CVA and gastroduodenal hemorrhages combination should have undergone anti-ulcer drug therapy.
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