Linear Blood Flow Velocity Research Articles

Analysis of the vascular abnormalities of the patients with ankle joint mild osteoarthritis

The vascular factor is one of the leading pathogenesis factors in the formation of ankle joint osteoarthritis. Dystrophic and sclerotic changes in the joint tissues develop as a result of blood flow decrease. These mechanisms understanding will allow to plan treatment and rehabilitation measures, as well as predict and prevent complications. The purpose of the work is to study hemodynamic parameters in the main lower leg arteries of the in patients in follow-up period of mild ankle joint osteoarthritis. Two groups of patients were examined. The first group - 82 patients with mild ankle joint osteoarthritis in the follow-up period (10 years) and the second group - control (healthy) group of 58 people without ankle joint osteoarthritis. Duplex scan of the main lower leg arteries was performed to all the patients. The state of arteries and hemodynamic parameters were evaluated. Excell and STATISTICA 10.0 programs were used for statistical data processing. In patients with follow-up of mild ankle joint osteoarthritis, the diameter of the arteries did not differ from the control group. In patients with mild ankle joint osteoarthritis the thickness of the Intima-media complex in the lower leg arteries and walls pulsation were significantly higher than those in patients of the control group (p <0.05). Analysis of hemodynamic parameters in patients with ankle joint osteoarthritis revealed an increase in the linear velocity of blood flow with a further tendency to normalization and even decrease in the follow-up compared with the control group. Signs of perfusion difficulty that accompanied the development of high blood pressure syndrome in the lower leg arteries were observed in 122 (67.0%) patients, and the signs of perfusion difficulty were bilateral in most of the cases (86.9%). Stenosis, deformation and arteries tortuosity were noted in 22% of patients with ankle joint osteoarthritis. Thus, mild ankle joint osteoarthritis is accompanied by blood flow changes in the form of inadequate perfusion and high-pressure syndrome in the lower leg arteries, which can cause secondary injuries and requires higher attention when selecting treatment and rehabilitation actions.

Comparative evaluation of anesthesia methods for reconstructive carotid surgery

The objective: to assess the impact of total intravenous and combined anesthesia (consisting of regional block and inhalation anesthesia with sevoflurane) on higher mental functions, frequency and nature of postoperative complications in carotid endarterectomy.Subjects and methods. A total of 190 patients with ipsilateral carotid stenosis exceeding 70%, or with the unstable atheromatous plaque were examined. CE was performed in 140 (73.6%) patients, while 50 (26.4%) patients underwent plasty with the autovenous patch. 60 patients had total intravenous anesthesia. The other 60 patients had combination anesthesia (cervical plexus block as per A. Yu. Paschuk + non-inhalation anesthesia with thiopental sodium). In 70 patients, low-flow inhalation anesthesia with sevoran and potentiation of the analgesic effect by bolus administration of fentanyl was performed. The parameters of central hemodynamics, cerebral blood flow, markers of cerebral damage, and state of higher mental functions were assessed.Results. Inhalation anesthesia with sevoflurane was characterized by decrease of total peripheral resistance index by 20% (p = 0.002) and SBP by 13% (p = 0.004) compared to baseline values. Moderate reduction of afterload was accompanied by normalization of cardiac and stroke indices. Optimization of the central hemodynamic parameters led to high levels of the linear velocity of cerebral blood flow and cerebral perfusion pressure which at the main stages of the operation did not differ from the control values. At the end of the operation, a statistically significant insignificant increase in intracranial pressure was noted (on average, by 4 mm Hg exceeded values at the previous stages, p = 0.014) and levels of markers of ischemic neuronal damage: the levels of antibodies to protein S-100 increased by 14% (p = 0.043), and NSE – by 2.8 μg/L. During inhalation anesthesia with sevoflurane, the lowest number of postoperative neurological and cardiac complications was recorded; they developed only in 6 (8.6%) patients and distributed equally. However, more pronounced postoperative cognitive dysfunction was noted when this method of anesthesia was used.Conclusion. Each method of anesthesia provided an unequal level of cerebral protection from ischemic damage which was manifested by a difference in the severity of disorders of higher mental functions, the number and nature of postoperative neurological complications.

Effect of testosterone on lipid metabolism and endothelium in men with type 2 diabetes mellitus and hypogonadism

Abstract Background To date, knowledge about the effects of testosterone (T) on the cardiovascular system of men remains controversial and requires additional research. Especially the putative impact of T replacement therapy (TRT) on lipid metabolism and endothelial dysfunction as a starting mechanism for the development of cardiovascular pathology in men with type 2 diabetes mellitus (T2DM) presenting with T deficiency has to be elucidated. The aim of this work was to evaluate the effect of T replacement therapy on lipid metabolism and function of endothelium in men with T2DM and hypogonadism. Methods The study included 95 men (mean age 55,3±2,4 years) with T2DM and late onset hypogonadism, established according to EAU 2015 criteria. Parameters of carbohydrate and lipid metabolism, as well as ultrasound assessment of flow-mediated dilatation of the brachial artery (FMD-BA) and intima-media thickness (IMT) of brachial arteries were performed at baseline and after 9 months. Patients were randomized into 2 groups: 1 - 45 men receiving TRT, using 1% transdermal T-gel and 2 (control group) - 50 men, who were not assigned to TRT. Statistical analysis was carried out using the Wilcoxon - test for repeated measurements (STATISTICA 10 software package). Results During the treatment period no serious adverse events were registered. The study revealed a significant decrease in HbA1c (p<0.001), total cholesterol (p=0.009), triglycerides (p=0.004) and LDL (p=0.01) levels as well as an increase in HDL level (p=0.001) in the 1st group vs baseline and compared to the 2nd one. There was a decrease in IMT (from 1.0 [0.8; 1.1] to 0.7 [0.6; 0.9] mm, p=0.002) in the 1st group compared to the 2nd (p<0.001). The endothelium-dependent FMD-BA increased 1.5 - fold in men applying T-Gel vs baseline as well as compared to the control group at the time point of follow- up (p<0.001). At the same time TRT leaded to acceleration of the time until maximal vasodilation – it became twice faster (from 120 [90; 120] to 60 [60; 90] sec, p<0.001) compared to baseline and the 2nd group (p<0.001). Linear blood flow velocity increased markedly in the 1st group compared to the 2nd at the time point of follow-up (p=0.03). Conclusion TRT in men with T2DM and T deficiency leads to an improvement in carbohydrate and lipid metabolism together with a significant decrease in IMT and enhancement of endothelium vasomotor function, seems to facilitate a reduction in cardiovascular risk. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Russian Science Foundation

Age and Sex Differences in Cerebral Circulation in Patients with Cerebral Atherosclerosis and Diabetes mellitus

Cerebrovascular pathology and metabolic disorders are problems of modern health care, which are of colossal medical and social significance. A high percentage of not only mortality, but also disability determines the extreme urgency of studying their various aspects, and the presence of combined pathology requires the development of a personalized approach to the tactics of managing such patients.The objective: was to determine sex and age differences in the structural and functional state of the vessels of the carotid and vertebro-basilar basins in patients with stage I–III cerebral atherosclerosis (CA) and type 2 diabetes mellitus.Materials and methods. A comprehensive clinical and instrumental study involved 229 patients with stageI–IIICA and type 2 diabetes mellitus. The patients were divided into 2 groups: I – the general group of patients who had an ischemic atherothrombotic stroke in the middle cerebral artery basin – CA III; II – with CA I–II stages. All patients underwent conventional clinical, laboratory and instrumental studies (Doppler ultrasound of the vessels of the head and neck – study of cerebral blood flow in the extra- and intracranial sections of the main arteries of the head and neck using the Aplio XG device (Toshiba).Results. In patients of group I, there were no age or sex differences in the linear systolic blood flow velocity (LSBFV) of the vessels of the carotid and vertebro-basilar basins. In group II patients over 60 years of age, the LSBFV in both internal carotid arteries was statistically significantly higher than in middle-aged patients, while the LSBFV in the left vertebral, posterior cerebral arteries and the basilar artery was statistically significantly higher in middle-aged patients than in the elderly. In our opinion, these differences can be explained by statistically significant differences in fasting blood glucose levels. It is important to note that statistically significant sex differences were found only for LSBFV in both common carotid arteries: in women with CA stages I-II, the rate of cerebral blood flow was higher than in men.Conclusions. For patients with stage III CA and T2DM, age and sex differences in the parameters of cerebral circulation both in the vessels of the carotid and in the vessels of the vertebro-basilar basins have not been established. Elderly patients with stage I–II CA and T2DM, in comparison with middle-aged patients, are characterized by a statistically significantly higher LSBFV in the vessels of the carotid basin and lower in the vessels of the vertebro-basilar basin. The rate of cerebral blood flow in female patients with stage I–II CA and diabetes mellitus is statistically significantly higher in both common carotid arteries, in contrast to the corresponding LSBFV indicators in male patients.

THE EFFECTIVENESS OF TREATMENT OF CERVICAL SPINE PATHOLOGIES ASSOCIATED WITH UNDIFFERENTIATED CONNECTIVE TISSUE DYSPLASIA IN CHILDREN

Introduction. The article background a necessity to timely perform conservative treatment of cervical spine pathologies associated with undifferentiated connective tissue dysplasia in children. Their treatment should consider all structural features of the cervical spine, its blood supply and concomitant pathologies which may be identified by diagnostic algorithms of multidisciplinary approach. Material and methods. In 2018-2020, 177 children with cervical spine pathologies associated with undifferentiated connective tissue dysplasia were conservatively treated in Morozovskaya Children’s City Clinical Hospital. All children were randomized into 3 groups which were prescribed different treatment modalities. In Group I, patients had standard treatment (exercise therapy, isometric gymnastics, massage, apparatus therapy); in Group II, head holders were added to standard treatment; in Group III, medicamentous therapy was added to standard treatment and head holders (magnesium lactate dihydrate and pyridoxine hydrochloride, levocarnitine). The instrumental examination revealed that all studied children had phenotypic signs of syndromes of undifferentiated connective tissue dysplasia and signs of pathology in the cervical spine. The average follow-up period was 24 months (6 months - 2 years). The average age of patients was 10 ± 3 years (5-17 years). Results and discussion. In order to assess the effectiveness of treatment, a comparative analysis of findings obtained at objective examinations was made before treatment and in 6 and 12 months after it. The examinations included: measurements of linear blood flow velocity in the vertebral arteries with ultrasound Doppler of the brachycephalic vessels; X-ray measurements of the cervical spine (Cruvelier joint and various displacements in vertebrae). The analysis performed has shown that the best results were registered in Group III. Conclusion. Findings obtained after catamnestic and instrumental examinations have showed that the complex treatment of cervical spine pathology, associated with undifferentiated connective tissue dysplasia in children, should include not only standard treatment (physical exercise trainings, massage, apparatus therapy) but also cervical orthoses and medicamentous therapy. Such a combined treatment has more pronounced therapeutic effect.

Мониторинг скорости кровотока в венулах брыжейки крыс

Development of systems for recording and automatic processing of information about direct microvascular responses is an important task for a preclinical study of drugs influencing the microcirculation. The aim was to modify the method for on-line recording and processing of intravital images of microvessels to study changes in the blood flow velocity under disturbing impacts. Method. This article presents an improved technique for recording linear blood flow velocity in microvessels and for processing intravital images. Macroscope (Wild M420, Switzerland), lens (Makrozoom 6.3-32x), and high-speed digital camera (Basler acA2000-165uc USB3.0, Germany) with a CMOSIS CMV2000 matrix were used for visual tracking of changes in blood flow velocity. The camera allows obtaining full-frame, 2000x1000 pixel images with a frequency of 165 fps, and linear images with a frequency of 8000 fps to capture a wide range of linear blood flow velocities. The scale of an image obtained with the microscope-camera system is 0.7 microns per pixel, which makes it possible to measure velocities of 0.1 to 150 mm/s. Digitizing and analyzing images were performed with a MultiMedia Catalog software, Version 2.3 (MMCatalog, Russia). The analysis of blood flow velocity is based on direct measurement of the blood cell flow velocity. The velocity is measured by estimation of the shift of blood cell flow for a predetermined time period between two measurements. To this purpose, a linear marker oriented along the vessel is applied to the blood flow image in a selected section of the microvessel. Following the measurement onset, the camera switches to a linear mode along the marker every second. A series of 5–6 measurements of linear images is taken at definite time intervals. Then measurements are used for construction of optical slices and measurement of the relative shift of the curve. The curve shift is determined by estimating the sum of differences between two arrays of curve brightness in scanning from –20 to +20% of the current position. The position corresponding to the minimum sum of differences is considered the value of curve shift. This procedure is performed for all 5-6 pairs of measurements. From the obtained values of curve shifts a median is selected, which is used as a result of measuring the velocity. Then the camera is again switched to the full-frame shooting mode, which allows you to control the position of the marker in real time. During the experiment, the object may move due to movements or breathing of the animal. To adjust the marker position on the image, it is possible to change its position during the measurements. The program captures the obtained values of curve shits and, thereby, the blood flow velocity. Based on the blood flow velocity, the program allows adjusting the number of measurements per unit time, which makes it possible to maintain stability of velocity measurements. To reduce the effect of high-frequency noise the curves are smoothed using moving averages. The averaging intensity can be adjusted in the process of measurement. Recording of blood flow velocity in a selected area is performed continuously during the entire experiment. Experimental protocol: – recording of the initial blood flow for 180 s – recording of blood flow during laser irradiation for 300 s – recording of blood flow after the exposure for 300 s. Results. This method of recording blood flow velocity allows recording increases in venular blood flow velocity both during and after an exposure to laser irradiation (662 nm). Conclusion. The proposed technique for processing intravital images of blood flow makes it possible to record fast changes in blood flow velocity in microvessels under disturbing impacts in real time.

Estimation of efficiency of shock wave therapy in patients with chronic nonbacterial prostatitis / chronic pelvic pain syndrome

Estimation of efficiency of shock wave therapy in patients with chronic nonbacterial prostatitis / chronic pelvic pain syndrome

Blood flow condition in the left renal vein in operative treatment of patients with varicocele

The purpose of the study was to evaluate the blood flow in the left renal vein after ligation of the internal spermatic vein with varicocele and to study the changing of the level of biological markers of acute kidney damage in these patients.
 Materials and methods. Under observation were 64 men in age 1823 years with the first hemodynamic type of varicocele. In 3 patients clinically significant compression of the left renal vein was revealed and the remaining 61 patients underwent surgery by Ivanissevich approach. Before the operation, on the 2nd, 10th, 30th and 90th days after the operation patients underwent Doppler blood flow rate by ultrasound with color mapping of the left renal vein with measurement of venous blood flow velocity. During these periods all patients underwent laboratory tests, including the study of the content of cystatin C and interleukin 18 in the blood and urine.
 Results. On the first day after ligation of the internal spermatic vein an increase in the concentration of biological markers of acute kidney damage in the blood and urine was noted. After surgery all patients showed an increase in the diameter of the left renal vein by 1.52 mm and a decrease in the linear blood flow velocity in the region of the renal vien by 56 cm/s. On the 10th day after the operation the diameter of the left renal vein was increasesd by 34 mm more and the linear blood flow velocity slows down by 22.5 cm/s. The restoration of blood flow velocity and the diameter of the left renal vein occurred within three months and in most cases returned to baseline and in 22.9% of patients recovery did not occur by the 90th day of observation.
 Conclusion. Ligation of the internal spermatic vein with varicocele is accompanied by impaired blood flow in the left renal vein and an increase in the concentration of biological markers of acute kidney damage, which is a manifestation of venous hypertension and renal hypoxia. In most patients these indicators normalize to the 90th day of observation after surgery.

Comparative results of isolated profundoplasty and distal bypass surgery in patients with diabetes mellitus and trophic ulcers

Aim. To compare the results of lower limb revascularization in patients with diffuse lesions of lower limb arteries who underwent femoral-distal bypass surgery and isolated reconstruction of the deep femoral artery (DFA) in the immediate postoperative period.Materials and methods. The study included 86 patients with diffuse arterial lesions of lower extremities, 52 (60.4%) men and 34 (39.6%) women with the average age of 67.3 ± 16.8 years. All patients had diffuse lesions of the arteries below the Poupart’s ligament; the condition of the lower leg arteries was 5–8.5 points on the Rutherford scale. Trophic ulcers were present in all cases. Group 1 included 48 patients who underwent reconstruction of lower leg arteries. Group 2 included 38 patients whose surgical intervention was limited to endarterectomy from the common femoral and deep femoral arteries.Results. In the early postoperative period, 1 (2.1%) patient (from group 1) died from developed myocardial infarction. The patient underwent a femoral-popliteal-tibial bypass surgery with a composite Y-shaped graft. In group 2, no fatal complications were observed. After the operation, all patients demonstrated an increase in the linear blood flow velocity in the arteries of the foot and the transcutaneous oxygen tension (TOT). The TOT level 14 days after surgery comprised 44.1 mm Hg and 39.9 mm Hg (p> 0.05) in groups 1 and 2, respectively.Conclusions. In 86.8% of patients, isolated profundoplasty followed by vasotropic therapy allows the target values of TOT to be obtained, which is necessary for successful healing of lower limb trophic ulcers.

Influence of various methods of hernia repair on the state of blood flow in the vessels of the ­spermatic cord and germination function of the testicle in men with inguinal hernias

Aim. Study of the influence of various methods of hernia repair (auto- and allo-) on testicular blood supply and hormonal background in mature men with inguinal hernias.
 Methods. Among 82 male patients aged 1860 years with various clinical forms of inguinal hernias, the effect of Trabucco allohernioplasty (20 patients) on the blood supply and reproductive function of the testicles was studied in comparison with Girard (19 patients) and Postempskiy autohernioplasty (22 patients), as well as Lichtenstein alloplasty (21 patients) in dynamics before and after 1, 6 and 12 months after surgery. The linear velocity of blood flow in the testicular artery (a. testicularis) was determined at the point of its exit as part of the spermatic cord from the outer ring of the inguinal canal using the ultrasonic diagnostic system using a linear sensor with a scanning frequency of 7.5 MHz. After identification of the testicular artery, the systolic linear velocity of blood flow in this artery was determined on the side of hernial protrusion, as well as on the intact side. At the same time, the concentration of total testosterone in the peripheral blood was studied by the ELIZA method.
 Results. In the postoperative period (for 1 year) we recorded a decrease in linear velocity of blood flow in comparison with the baseline preoperative level in patients with inguinal hernias after all methods of hernioplasty. However, the greatest decrease of linear velocity of blood flow was observed afer local tissue hernioplasty by Girard (by 2.8 cm/sec, 14.9%; p 0.01) and by Postempskiy (by 3.4 cm/sec, 17.5%), and the least after alloplasty by Lichtenstein (by 0.5 cm/sec, 2.7%; p 0.05) and alloplasty by Trabucco (by 0.1 cm/sec, 0.5%; p 0.05). It was revealed that in patients (men) with inguinal hernias, testosterone level in the blood 1 year after autohernioplasty by Postempsky significantly (p 0.01) decreased by 6.8%, after autoplasty by Girard by 4.3% (p 0.05), after hernioalloplasty by Lichtenstein by 3.4% (p 0.05). At the same time, after Trabucco allohernioplasty, a decrease in the level of testosterone in the blood did not occur, and, on the contrary, a non-significant (p 0.05) trend of its increased production by 0.5% 12 months after surgery was revealed.
 Conclusion. The studied methods (especially autoplasty by Postempskiy and Girard) have a pronounced negative impact on the blood supply and the germination function of testicles with significant reduction in the concentration of testosterone in the blood; except allohernioplasty according to the method of Trabucco, after which along with the smallest flow reduction (by 0.5%; p 0.05) no increase of the concentration of this hormone occurs.

A trial of the use of perfusion computed tomography of the brain in combination with transcranial Doppler ultrasonography of blood vessels in patients with acute cerebrovascular accident

Aim. Assessment of cerebral blood flow in various vascular beds in patients with an acute cerebrovascular accident in the acute period by perfusion computed tomography in combination with transcranial Doppler ultrasonography of cerebral vessels.
 Methods. Data was analyzed from perfusion computed tomography of the brain and transcranial Doppler ultrasonography in 35 patients with an acute cerebrovascular accident, based at the vascular centre of the City Clinical Hospital No. 7 of Kazan. The study included 18 (51.4%) women and 17 (48.6%) men who had arrived in the first hours after a vascular accident. When analyzing the stroke subtype, atherothrombotic subtype was determined in 27 (77.1%) patients, cardioembolic subtype in 5 (14.3%) patients, and 3 (8.6%) patients had had a transient ischemic attack.
 Results. Perfusion computed tomography is a method that allowed evaluation of the structure of the brain, and blood supply to the anterior cerebral (in 2.9% of the studied patients), middle cerebral (in 62.9% of the studied patients), posterior cerebral (in 11.4% of the studied patients) and vertebral (in 14.2% of the studied patients) arteries of patients with a stroke. The method revealed a zone of critical perfusion (ischemic penumbra) by quantitatively processing perfusion indicators in the anterior cerebral blood flow system (decrease in rate and increase in average volume of cerebral blood flow and average transit time) and in the posterior cerebral circulation system (decrease in blood flow and prolongation of transit time) in the bed of the right vertebral artery). The method also aided the construction of perfusion maps. Transcranial Doppler ultrasonography of cerebral vessels revealed breaches in the cerebral circulation: a decrease in the linear velocity of blood flow in the right middle cerebral arterial bed and in the posterior circulatory system of blood flow in the brain, and an increase in the pulsatility index in all the studied vascular beds.
 Conclusion. Perfusion computed tomography of the brain in combination with transcranial Doppler ultrasonography is applicable to patients with stroke in various vascular beds, followed by determination of indications for thrombolytic therapy and thrombectomy.

H-shaped partial splenorenal shunting with the use of a reinforced graft made of porous polytetrafluoroethylene.

The study was aimed at improving the immediate and remote results of splenorenal bypass grafting. A total of 57 patients presenting with hepatic cirrhosis, portal hypertension, and recurrent haemorrhage from oesophageal varices underwent an H-shaped partial splenorenal shunt procedure using an externally reinforced 1.5-2.0-cm-long synthetic graft with a diameter equalling half of that of the splenic vein in an end-to-side fashion. Assessment of efficacy of shunting was based on intraoperative measurement of venous pressure in the portal system before and after shunting, the findings of Doppler ultrasonography of the linear velocity of blood flow in the portal, splenic, and left renal veins in the early postoperative period, as well as computed tomography, esophagogastroscopy, and assessment of the degree of hepatic encephalopathy in the remote postoperative period. The findings of intraoperative measurement of venous pressure in the portal vein system before and after shunting demonstrated a statistically significant decrease in (normalization of) portal pressure in all patients after bypass grafting (p≤0.05). There were no severe postoperative complications, in-hospital mortality, nor events of decompensation of hepatic insufficiency. According to the findings of Doppler ultrasonography of the linear velocity of blood flow and control computed tomography after surgery, the splenic vein, left renal vein and the conduit between them remained patent at all terms of postoperative follow up. The findings of control esophagogastroscopy revealed a statistically significant decrease in the degree of oesophageal varices at 3, 6, and 9 months after shunting (p≤0.05). There was no statistically significant difference in the change of the degree of hepatic encephalopathy at 3, 6, and 9 months after shunting (p=0.853, p=0.712, and p=0.581, respectively). At various terms after surgery, nine patients underwent deceased donor liver transplantation, with the splenorenal shunt ligated intraoperatively. This method of splenorenal shunting makes it possible to decrease the risk of bleeding from oesophageal varices and venous thromboses in vascular anastomoses, as well as complications resulting from using autovenous conduits, to decrease the risk of decomposition of hepatic insufficiency and the frequency of the development of encephalopathy in the postoperative period. Besides, this method makes it possible to easily dismantle the previously created artificial portocaval shunt in the process of liver transplantation.

Clinical effectiveness of «thresholdless» low-frequency transcranial magnetic stimulation in patients with ischemic stroke

As you know, complete successful recovery in stroke patients occurs only in 8% of cases, 20% need constant care. The use of innovative rehabilitation technologies, namely «thresholdless» low-frequency transcranial magnetic stimulation, will speed up the process of restoring impaired functions, increase independence in everyday life and, accordingly, the quality of life. To evaluate the effectiveness of use of low-frequency «thresholdless» transcranial magnetic stimulation in the treatment of patients in acute period of ischemic stroke. The study included 93 patients aged from 49 to 68 years on second-third days of ischemic stroke. The 1st (main) group (n=48) received low-frequency «thresholdless» transcranial magnetic stimulation from the «Diamag» apparatus (AlMag-03) daily for 20 minutes, course - 8-10 procedures, with the background of drug treatment, and in addition to classes with an exercise therapy instructor and an occupational therapist. In the 2nd (control) group (n=45), standard therapy was carried out in accordance with the Procedure for rendering medical care to patients with stroke, only with the exception of physiotherapy. Assessment methods: clinical and neurological examination, indicators of duplex scanning of brachiocephalic vessels, Rivermead mobility index, modified Rankin scale, FIM scale (Functional Independence Measure), Hospital anxiety and depression scale (HADS). In patients of the 1st (main) group, an increase in the linear velocity of blood flow in the internal carotid artery on the side of lesion was revealed by 18.1% when compared with the 2nd (control) group (p=0.042); mobility increased by 42.1%, functional independence in everyday life - by 38.1%, muscle strength - by 50%, compared with the 2nd (control) group (p=0.0005). According to the HADS scale, in 29 (60.8%) patients of the main group, psychoemotional disorders were not detected, neither a single case of significantly expressed symptoms of depression (p<0.0001). The inclusion of low-frequency transcranial electromagnetic stimulation in complex rehabilitation leads to the regression of movement disorders, reduces the level of anxiety and depression, improves daily activity and, as a consequence, the quality of life.

FEATURES OF CEREBRAL CIRCULATORY DYNAMICS AND CEREBRAL BIOELECTRIC ACTIVITY IN CHILDREN WITH CRANIOCEREBRAL INJURY

In order to study the state of cerebral hemodynamics and to investigate the electroencephalographic characteristics in children with closed traumatic brain injury, 114 patients were examined. The children were examined in 6.1±0.8 months after a traumatic brain injury. To determine cerebral hemodynamics, transcranial dopplerography was performed, the functional state of brain was evaluated according to electroencephalography. In the course of the study, it was noted that a disordered cerebral hemodynamics in children with moderate and severe brain contusion and its foci presence was accompanied by a rise in a linear velocity of blood flow, while its decrease was found at the same contusion, but that was severe and with the presence of subdural, subarachnoid and epidural hemorrhage. Signs of diffuse changes in bioelectrical activity of the brain were represented by a significant increase in an amplitude of the alpha rhythm in children with closed traumatic brain injury of moderate and serious severities compared to mild one. Key words: children, craniocerebral injury, electroencephalography, transcranial Doppler sonography, paroxysmal activity.

Ways of limbs salvage in postoperative period of treatment of complications of diabetic foot syndrome

The article deals with the use of a genetically engineered drug for stimulation of angiogenesis as a component of combined treatment of complications of ischaemic form of diabetic foot syndrome, showing comparative results of using therapeutic angiogenesis in patients in whom it was impossible to perform operative revascularization of the affected extremity, also providing a detailed description of the methodology of combined treatment of pyonecrotic complications of diabetic foot syndrome. The study included a total of 62 patients with pyonecrotic complications of Wagner grade III-IV diabetic foot syndrome. The patients were divided into two groups. Group One patients after minor amputation on the foot were assigned to receive conventional basic therapy and topical treatment of the foot wound with antiseptics and modern dressings. Group Two patients, besides basic therapy, additionally received combined treatment which was carried out in two stages and included urokinase, sulodexide, and a venotonic agent. Local treatment of the foot wound was performed with the help of two-stage vacuum therapy. Both groups were further subdivided into subgroups A and B. The patients in subgroups B of both groups in order to prevent progression of limb ischaemia were additionally given Neovasculgen, a genetically engineered drug for stimulation of angiogenesis. The patients of subgroups A of both groups did not receive this drug. The immediate results were assessed on the 1st, 7th and 14th days of treatment by the dynamics of changes in subjective symptoms, cytograms of the wound surface, level of partial pressure of oxygen in capillary blood of foot tissues, and the necessity to perform repeated necrectomy. The remote results were evaluated by the dynamics of changes in the pain-free walking distance, maximum distance walked, ankle-brachial index, linear velocity of blood flow through tibial arteries and partial pressure of oxygen in capillary blood of the affected limb at the 6th, 12th and 36th months after the performed treatment, as well as by the limb salvage and patients' survival during 3 years.

Mechanisms of chronic stress influence on the brain hemodynamic in persons with employment-related chronic stress

To discuss the mechanisms by which chronic psychosocial stress (CPSS) affects the parameters of cerebral blood flow. One hundred and sixty locomotive machinists (LM) and machinist assistants (MA), whose profession is rated as one of the most stressful, were enrolled in this study. The control group consisted of 100 healthy volunteers. The activity of the stressor system was assessed by the levels of stress hormones in serum (ACTH, cortisol, adrenaline). The functional state of the endothelium was assessed by secretion of nitric oxide and endothelin-1. Doppler ultrasound was used to measure the linear velocity of blood flow in the cerebral vessels, the size of the intima-media complex of the common carotid artery, and the results of the endothelium-dependent vasodilation. Blood pressure was monitored daily. The action of CPSS is accompanied by the persistent increase in the serum cortisol levels. This process contributes to the development of vasoconstriction with the initiation of endothelial dysfunction with impaired production of nitric oxide and increased secretion of endothelin-1 and the formation of arterial hypertension. With progression of these processes, there is a decrease in cerebral blood flow. The observed increase in the size of the intima-media complex of the common carotid artery correlates with the severity of arterial hypertension and endothelial dysfunction. CPSS leads to a decrease in cerebral blood flow and subsequent development of endothelial dysfunction and arterial hypertension, which are related to high levels of stress hormones circulating in the blood. These processes lead to functional failure of the vascular endothelium.

ПРИМЕНЕНИЕ КИНЕЗИОТЕЙПИРОВАНИЯ ПРИ ЗАДНЕМ ШЕЙНОМ СИМПАТИЧЕСКОМ СИНДРОМЕ

The objective. To substantiate the use of kinesiotaping in the complex treatment of patients with posterior cervical sympathetic syndrome based on clinical studies. Patients and methods. The dynamics of dizziness was assessed using the DHI dizziness rating scale (Dizziness Handicap Inventory) and the VRBQ (Vestibular Rehabilitation Benefit Questionnaire) vestibular questionnaire among 60 patients, and headache and neck pain dynamics were assessed using a visual analogue scale (VAS) to assess the dynamics of complaints of tinnitus, blurring of vision, nausea, vomiting, heart attacks, decreased concentration and attention were used by the International Classification of Functioning, Disability and Health (ICF), to evaluate the dynamics of blood flow, we used duplex scanning of the brachycephalic arteries, to assess anxiety self-assessment scale Sheehan anxiety, for assessing depression Beck depression scale. Results. In the kinesiotaping group, statistically reliable data were obtained (p&lt;0.05) for reducing dizziness, headache, cervical pain, a decrease in tinnitus, defocusing of vision, and a decrease in concentration and attention. Statistically reliable data were obtained (p&lt;0.05) for improving linear blood flow velocities (Vm, Vps) on the left vertebral artery at an extracranial level. Statistically reliable data were obtained (p&lt;0.05) for the effectiveness of kinesiotaping for the correction of upper cross syndrome. Conclusion. The use of kinesiotaping can be recommended for the correction of biomechanical disturbances, correction of the upper cross syndrome, as well as for the treatment of patients with posterior cervical sympathetic syndrome and increase in linear blood flow velocities through the vertebral arteries.

Особенности состояния сосудов у детей с соединительнотканной дисплазией сердца

The article presents the results of a study of Doppler ultrasound (USDG) of arteries and veins of the upper and lower extremities of 68 children with connective tissue dysplasia of heart. When examining the veins, functional tests were carried out: Valsalva’s test and a test with compression by a sensor. In children with connective tissue dysplasia of heart and concomitant arterial hypertension, the failure of the valves of saphenous veins is more common. Also, the following pathologies are revealed: chronic venous insufficiency, angiodysplasia, congenital hypoplasia and aplasia of the deep veins of the lower extremities. Examination of the arteries revealed a spasm of the arteries of the upper and lower extremities with a constant thickness of intima-media, Raynaud’s syndrome. In such patients, the linear blood flow velocity decreases, mainly in the deep arteries of the upper and lower extremities. Doppler ultrasound should be used for early detection of changes in the arteries and veins of the upper and lower extremities in order to prevent and treat vascular diseases.

Surgery for distal ischemia of the upper limbs correction

The aim — to study the surgery efficacy on the distal parts of the arteries in the treatment of acute limb ischemia.Materials and methods. A comparative analysis of the results of thoracic and periarterial sympathectomy in patients with various occlusive diseases of the distal arteries of the upper extremities was performed. From 2001 to 2013, 68 patients with chronic ischemia of distal upper extremities were operated. Men were 44, women — 24. Age varied from 26 to 92 years, the average age was 49.09 years.Results and discussion. In all patients who underwent interventions on the palmar arterial arch, the main blood flow was restored. The data of triplex scanning of the palmar arterial arch and digital arteries and transcutaneous oximetry indicated an increase in the linear blood flow velocity and a decrease in the indices of peripheral vascular resistance in all cases. The linear blood flow velocity in patients with thromboangiitis obliterans after performing digital periarterial sympathectomy increased on average by 64 %, in patients with Raynaud’s syndrome — by 100 %, in patients with obliterating atherosclerosis — by 135 %.Conclusions. The obtained results showed that the revascularization effect of desimpation is the higher, the more distantly eliminated sympathetic nerve fibers. Periarterial digital sympathectomy gives a pronounced long‑lasting effect, which makes it possible to consider it as a method of choice for the treatment of acute arm ischemia. Direct intervention on the arterial arch of the hand in some cases allows to restore the main blood flow, which significantly improves treatment results.

SURGICAL METHODS OF TREATMENT OF CHRONIC DISTAL ISCHEMIA OF UPPER EXTREMITIES

Summary. Introduction. Indications for operations on the arterial arc of the brush can bediagnosed distal thromboembolism, thrombosis and occlusion of the arteries with stored the main blood flow through the arteries of the forearm. Purpose of the study. Improve the treatment results for patients with chronic upper limb ischemia. Materials and methods. We have analyzed the result of the treatment of 64 patients with chronic arterial ischemia of the upper limbs. All interventions were performed under conduction anesthesia by interscalene brachial plexus block under ultrasound control. Results. Digital periarterial sympathectomy gives a pronounced long-lasting effect, it can be regarded as a method of choice in the treatment ucral ischemia of the hand. Direct intervention on arterial arch of hand in some cases allows to restore the main blood flow, which significantly improves treatment results. Data triplex scanning arterial arch of the hand and finger arteries and transcutaneous oximetry indicate the increase of linear blood flow velocity and decrease of the index of peripheral vascular resistance in all cases. Dynamics of evaluation of serum nitric oxide and VEGF in venous blood of the affected limb shows the increase of the studied parameters, confirming the effectiveness of sympathectomy to improve blood supply. Conclusions. Digital periarterial sympathectomy in Raynaud’s syndrome and obliterating atherosclerosis allows to achieve better treatment results than the rib sympathectomy.