Vol 3, No 2 (2009)

The study of endothelial vasomotor function (EVF) and global arterial distensibility (glAD) aimed at determining their role in the development and progression of cerebral disturbances in arterial hypertension (AH) was conducted. We investigated 292 patients with different clinical forms of hypertensive cerebrovascular diseases (CVD). EVF was assessed with the use of endothelium-dependent flow-mediated vasodilatation of the brachial artery, and glAD was calculated as stroke volume (by echocardiography)/pulse pressure ratio (ml/mm Hg). Reduced EVF was revealed in patients versus controls: 7.2% (5.9; 8.2) and 10.5% (10.0; 12.9), respectively (p<0.001). EVF values were similar in patients with both early and late progressive stages of CVD. glAD was inversely correlated with the grade and duration of AH, patient age, and presence of deformations or atherosclerotic lesions of brachiocephal arteries, and it was diminished only in hypertensive encephalopathy, stage II–III [1.34 ml/mm Hg (1.11; 1.56) and 1.33 ml/mm Hg (1.13; 1.73)]. Thus, endothelial dysfunction is the earliest abnormality of vascular functional properties in AH and may be regarded as a universal factor of cerebrovascular complications. Reduced glAD reflects the loss of arteasticity and may represent a predictor of progressive course of CVD.

Dynamic study of the blood levels of cytokines (interleukins IL-1β, IL-6, IL-1O and TNFalfa) was carried out in 40 patients with different outcomes of acute severe head injury. It was shown that severe head trauma resulted in the disbalance of pro- and antiinflammatory cytokines. During the first 24 hours, the direction of pathologic shifts did not differ between different patient groups and was characterized by the increase in IL-1β, IL-6 and IL-10 concentrations. By week 3, the decrease in concentrations of both pro- and anti-inflammatory cytokines was found in patients who had been discharged from the hospital for ambulant therapy. In cases of fatal outcome, deterioration of general condition of patients was combined with the decrease in IL-1β  concentration and the considerable increase in IL-6 and IL-10 concentrations, which may be regarded as one of unfavorable prognostic signs of head injury.

116 patients with clinical manifestations of thoraco-cervical osteochondrosis with reflectory vertebral-basilar and vertebral-cardial disorders have been examined. 64 patients (basic group) along with traditional therapy of thoraco-cervical osteochondrosis underwent a course of intraosteal blockades, while 52 patients (comparison group) received traditional therapy with a course of paravertebral blockades. Effectiveness of treatment was assessed by the dynamics of pain syndrome parameters using Visual-Analog Pain Scale, Russian version of McGill pain questionnaire, “body scheme” questionnaire, as well as by hemodynamics parameters, cardiac rhythm variability, and examination of cognitive functions. More significant effect of intraosteal blockades in the complex treatment of the patients under study, compared to paravertebral blockades, was revealed. Clinical manifestations of both vertebral-basilar and vertebral-cardial spondilogenic disorders significantly regressed after intraosteal blockades. Osteogenetic factor can be considered as a universal mechanism of the forming of complex spondilogenic vertebal-basilar and vertebral-cardial disorders.

Review of the literature on the problem of semiotics of pathological processes in the region of the cavernous sinus is presented. Discussed in detail are clinical picture, course, prognosis and methods of verification of the cavernous sinus syndrome, and extreme clinical heterogeneity of this condition is stressed. Main attention is focused on questions of vascular genesis in the development of this syndrome and, primarily, on aneurism of the internal carotid artery. In the review, a detailed analysis of the topic approach in differential diagnosis of the cavernous sinus syndrome with other clinically similar disorders is given.

Despite the progress of angioneurology and vascular surgery, in multiple and combined lesions of the aortic arch branches the questions of indications and contraindications to surgery, surgical tactics, and types and order of operations remain disputable. In the paper we present an example of combined surgical revascularization of the brain in a patient with abnormal circulation in both carotid and vertebrobasilar systems resulted from multiple atherosclerotic lesions of the brachiocephal arteries. The expanding application to practice of non-invasive endovascular methods, used along with traditional reconstructive operations on vessels, broadens significantly the opportunities for surgical treatment in this complex group of patients.