Disturbances Of Higher Cortical Functions Research Articles

Energy-structural status in perioperative sedoanalgesia

The use of minimally invasive surgical techniques and sedoanalgesia contributes to significant progress in reducing perioperative complications, as well as in reducing the length of stay for in-patients, but the problem of the violation of energy-structural interactions in the patient's organism, which subsequently leads to disturbances of higher cortical functions, remains topical. The energy-structural status (ESS) of the organism and the central nervous system specialized cells vital activity disorders are still unexplored.Aim. Improving treatment outcomes for patients with acute intra-abdominal diseases by giving energy-protective capacity to sedoanalgesia and perioperative management.Materials and methods. The research was performed on the results of the perioperative energy-structural activity (ESA) audit, its reserves, properties, and the effectiveness of autoregulation in 84 patients with acute intra-abdominal diseases. According to the initial level of energy-structural activity, all patients were divided into three groups: with dysfunction of the energy-structural status, with damage and insufficiency. Each group was randomly subdivided into treatment and control groups. Patients of the control group underwent standard sedoanalgesia, and patients of the treatment group underwent sedoanalgesia with the use of energy-protective techniques. At all perioperative stages a deep picture of the oxygen regime, acid-base, water-electrolyte balance, hemodynamic and microcirculation indices, basal metabolic rate were studied. Additionally, markers of early signs of neuronal damage were determined in 10 patients: neuroglial protein S100 and neuron-specific enolase NSE.Results. The close relationship between early manifestation of structural microdamages of brain cells and energy-structural changes in the patients' body was proved. The study of the neurospecific proteins level and dynamics of energy-structural activity parameters confirms that the use of energy-protective techniques significantly increases the perioperative energy-protective capacity of sedoanalgesia (p<0,05).Conclusions. Supplementation of standard sedoanalgesia with energy-protective techniques allows to supply anesthetic management of urgent abdominal surgery with energy-protective properties, providing the necessary energy-structural interaction, which makes it possible to reduce the severity of energy-structural status damage, that leads to decreased severity of neurons and neuroglia intracellular damage.

Dementia-current knowledge and significance for ENT specialists

Because of the growing number of elderly people, the incidence of dementia is increasing. This disease is a heavy burden for patients and their relatives, and has growing social and financial implications. The essential feature of dementia is an impairment in both short and long-term memory which is associated with an impairment in abstract thinking, impaired judgment, other disturbances of higher cortical functions, and/or personality change. Mild cognitive impairment represents a transitional state between the cognitive changes of normal aging and very early dementia, and is becoming increasingly recognized as a risk factor for Alzheimer's disorders. ENT specialists require knowledge on the basic problems in patients with (early) dementia and the most common diagnostic/therapeutic assessments. New therapeutic concepts such as cholinesterase inhibitors have been shown to interfere with the progression of Alzheimer's disease. In this report, the strategies in diagnostics and therapy which should be known by ENT specialists are presented.

On the structure of word deafness and mechanisms underlying the fluctuation of disturbances of higher cortical functions

A case of pure word deafness was studied with special reference to the structure and dynamics of the comprehension deficit. It was found that the deficit was of an acoustic nature and that it concerned linguistic and nonlinguistic material. No lateralization was found with a dichotic listening task. The linguistic deficit was restricted to the phonemic level, and increased from the beginning to the end of a syllable and with the number of syllables. If the patient did not understand a specific verbal stimulus, he could not tell whether it was a real word or a nonsense syllable complex. When examined on three successive days with the identical material, there was little fluctuation of the deficit. It was concluded that fluctuations, as described by other authors, are concerned not with the disorder as such but with a higher-order compensatory mechanism on the semantic level, and therefore cannot be seen with isolated words or syllable material. A similar explanation for fluctuations in other disorders of higher cortical functions was discussed.

EEG frequency analysis in the course of acute ischemic stroke.

In 18 patients with acute cerebrovascular disease (17 ischemic, 1 hemorrhagic stroke) neurological symptoms were scored repeatedly using a rating scale for disturbance of consciousness, motor dysfunctions, disturbance of higher cortical functions, abnormalities of cranial nerves, and impairment of sensations, and related to EEG-abnormalities quantified by frequency analysis. A correspondence between location of neurologic lesion and EEG focus was found in 87%, but correlation between neurologic score and the degree of EEG-abnormality was low. Changes of clinical defects were not significantly related to various quantified EEG parameters. These results suggest that computerized EEG analysis has to be used with caution for quantifying the clinical course of stroke patients.