The study objective is to analyze surgical outcomes in patients with hemorrhagic stroke treated by endoscopic aspiration in five regional vascular centers in Russia and to evaluate capabilities and benefits of this surgical procedure. Material and methods. The study included 296 patients with hemorrhagic stroke (with various locations of the hemorrhage) that underwent endoscopic aspiration between 2006 and 2018 at one of the following institutions: N.V. Sklifosovsky Research Institute for Emergency Medicine (Moscow), City Clinical Emergency Hospital No. 1 (Omsk), Regional Clinical Hospital (Yaroslavl), N.A. Semashko Republic Clinical Hospital (Simferopol), Irkutsk Regional Clinical Hospital. Neurosurgery departments of these healthcare institutions are the parts of regional vascular centers. We used Glasgow Outcome Scale to evaluate outcomes of surgical treatment. Results. Complete recovery was observed in 52 (17.5 %) patients, while 52 (17.5 %) patients developed moderate disability and 131 patients (44.5 %) developed severe disability. Four (1.5 %) patients developed a vegetative state. Fifty-seven (19 %) patients died after surgery. Conclusion. The experience of treating hemorrhagic stroke in five neurosurgical centers demonstrates that endoscopic aspiration of hypertensive intracerebral hemorrhages is in no way inferior to microsurgery. It ensures satisfactory results and can be used in patients with various hemorrhages.
Seismic observations by 46 stationary seismic stations, including seven temporary seismic stations located in the area of Novovoronezh and Kursk nuclear power plants, and by two arrays were carried out on the Russian territory of the East European Platform. A feature of seismicity in 2016–2017 is a manifestation of swarms of weak earthquakes in the northwest in the Leningrad region and the adjacent territory of Finland, as well as earthquakes on the Ukrainian Shield with Мs(est.)=3.8 in Krivoy Rog, where mass explosions are carried out in mines, but earthquakes of moderate magnitude МL=2.6–3.9 also occur (2007, 2013). Weak earthquakes in the peripheral parts (in the southwest, west and northwest) and in zones associated with paleorift structures: in the northeast – with the Kirov-Kazhim and Central Russian aulacogenes continue to be recorded. Weaker natural seismicity with ML≤2.5 was recorded in Karelia and the regions bordering Finland, near the Kandalaksha Bay, near the Khibiny and Lovozero massifs on the Kola Peninsula and in the territory of the Voronezh crystalline massif.
Objective. On the basis of own material determine the role of radical surgery methods in treating tubercular formations of the brain in HIV-infected patients.Materials and Methods. Studied: statistical forms of the SSPB of the IOKB from 2008 to 2020, FTBPR data from 2017 to 2020, nature of the disease in 56, long-term disease dynamics — in 8, the autopsy material of 331 dead and the biopsy — 9 patients operated on with central nervous system damage (CNS).Results and Discussion. The number of patients with tuberculous meningoencephalitis increases in the structure of in-patient facilities, case-fatality rate among them grows. Need for neurosurgical care among the survivors is 25%. Long-term monitoring of operatively treated patients shows their higher survival rate, significant clinical effect of surgery, lengthening of life, increase of CD4 lymphocytes by 2,7 times in 3,5 years after the surgery. Formation of restrictive processes around tuberculous lesion in CNS was noted when taking ART with low immune status.Conclusion. Radical removal of tubercular formations of CNS in HIV is reasonable.
Цель исследования -выявление факторов, позволяющих прогнозировать развитие и / или нарастание неврологического дефицита (НД) в послеоперационном периоде в случае преходящих критических изменений параметров (КИП) при регистрации транскраниальных моторных (ТКМВП) и соматосенсорных (ССВП) вызванных потенциалов во время клипирования интракраниальных артериальных аневризм.
The objective: to evaluate immediate and postponed results of surgical treatment of tuberculosis (TB) in patients with TB/HIV co-infection.Subjects and methods. 106 patients underwent surgery: 64 patients suffering from pulmonary tuberculosis (81.2% had resections, and 18.8% – thoracoplasty), 36 patients – tuberculous spondylitis (vertebral body resection in combination with anterior spondylodesis), and 6 patients – cerebral TB (removal of tuberculous lesions under neuronavigation). Development of complications in the postoperative period and tuberculosis relapses in the long-term period was assessed.Results. No severe and suppurative complications were observed in the postoperative period in patients with HIV/pulmonary TB and HIV/cerebral TB. In patients with HIV/TB spondylitis, complications were registered in 4/36 (11.1%) cases: in 2/4 – postoperative wound suppuration and in 2/4 – ligature fistulas. No relapse of tuberculosis was reported after lung resection in 45 out of 45 patients availabe for follow-up, after thoracoplasty in 10 out of 12 patients, after surgery due to tuberculous spondylitis – in 25 out of 27 patients, and cerebral tuberculosis – in 5 out of 6.
о. н. НОВИЦКАЯ1-2, С. и. ПЕТРОВ3, О. В. КАНЯ4 'ГБОУ ВПО «Иркутский государственный медицинский университет», г. Иркутск 2ОГБУЗ «Иркутская областная клиническая туберкулезная больница», г. Иркутск 3ГБУЗ «Иркутская областная клиническая больница», г. Иркутск 4ГУЗ «Областное патологоанатомическое бюро», г. Иркутск Цель исследования: определение порядка взаимодействия фтизиатров и нейрохирургов при лечении локального туберкулеза ЦНС у ВИЧ-инфицированных больных. Материалы и методы. Изучена гистологическая, микобактериологическая и рентгенологическая характеристики туберкулеза ЦНС у 73 умерших и 5 прооперированных ВИЧ-инфицированных пациентов. Результаты. Поэтапное лечение пациентов с локальным ВИЧ-ассоциированным туберкулезным поражением головного мозга включает консервативное лечение с поиском возбудителя в доступных биологических средах, при отсутствии эффекта от проводимой терапии-ре шение вопроса о биопсии с целью верификации диагноза и уточнения чувствительности возбудителя с последующим решением вопроса о радикальном удалении образования. Условием для проведения радикального оперативного вмешательства является антибактериальная подготовка в соответствии с данными о лекарственной чувствительности возбудителя до исчезновения зоны перифокального отека при нейровизуализации головного мозга. Ключевые слова: ВИЧ-инфекция, центральная нервная система, лекарственная чувствительность, биопсия, туберкулезный абсцесс голов ного мозга.
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