6 курс / Медицинская реабилитация, ЛФК, Спортивная медицина / Клиническая_геронтология_2009_№10_11_том_15

latory encephalopathy. Were discovered some character accentuations, which make risks of cognitive disorders in atherosclerotic dyscirculatory encephalopathy higher. It is established the emotionalindividual accentuations in different stages of discirculatory encephalopathy and its general types accentuation, including the social-pas- sive and the emotional stable. The emotional non-stable type is the risk factor of cognitive disorders at the development and the progression of atherosclerotic encephalopathy.

FEATURES OF THE OXYGEN SUPPLY OF BRAIN IN ELDERLY PATIENTS WITH CORONARY HEART DISEASE

Ye.N. Levicheva, I.Yu. Loginova, G.N. Okuneva,

V.G. Postnov, T.V. Tretyakova

Acad. E.N. Meshalkin Research Institute of the Pathology of Blood of Rosmedtechnology, Novosibirsk

This research is devoted to the evaluation of cerebral oxygen supply in elderly patients with coronary heart disease using cerebral oximetry. The reduction of cerebral oxygenation in patients over 65 years, as well as a large percentage of the critical reduction of cerebral rSO2 with apparent interhemispheric asymmetry of the brain were shown.

PHARMACOTHERAPY OF CEREBROVASCULAR ATHEROTHROMBOSIS

E.V. Portnyagina1, A.F. Portnyagin

Irkutsk State Medical University

Recommendations for the prevention of ischemic stroke in highrisk patients based on current data of randomized trials were developed. We analyzed the results of clinical trials and recommendations for the treatment of atherothrombotic processes in terms of evidencebased medicine.

MASKS OF ISCHEMIC STROKE

M.M. Vorontsov, S.E. Hatkova, M.A. Parfenov

I.M. Sechenov Moscow Medical Academy,

Therapeutic and Rehabilitation Center, Moscow

Nowadays there is an increasing number of patients admitted to the hospital with suspected ischemic stroke, it requires the improvement of differential diagnosis with other diseases, which manifest by sudden development of neurological disorders and remind the ischemic stroke (masks of ischemic stroke). 157 patients admitted to the hospital with diagnosis of «ischemic stroke» were examined. The diagnosis of ischemic stroke was confirmed only in 112 of 157 patients (71.3%). The remaining 45 patients (28.7%) had other diseases: haemorrhage of the brain (51.1%), diseases of the peripheral vestibular system (15.6%), Alcoholic encephalopathy (8.9%), brain tumor (4.4%), migraine (2.2%), neurosyphilis (2.2%) and acute psychosis (2.2%). We described elderly patient with benign paroxysmal positional vertigo, similar to the ischemic stroke. Knowledge of symptoms and diagnosis of diseases manifested by sudden neurological disorders helps in the differential diagnosis of ischemic stroke and contributes to good clinical practice.

GERIATRIC FEATURES OF COGNITIVE DISORDERS IN CEREBRAL STROKE

T.T. Kispaeva

Russian State Medical University, Moscow

This work was supported by the Russian Foundation for Humanities, project ¹ 08-06-00703à

Current geriatric aspects of formation and progression of cognitive disorders in cerebral stroke and its multifactorial nature were shown, the necessity of development and implementation of methods for diagnosis and treatment of cognitive disorders in cerebral stroke taking into account the geriatric specificity was substantiated. It would provide the improvement of the quality of life, prevention of cognitive defect typical for the elderly patients, and probably it would limit manifestation of inevitable cognitive disorders in cerebral stroke in this group of patients.

ASYMPTOMATIC VERTEBROBASILAR

INSUFFICIENCY

S.K. Volkov1, A.E. Zotikov, B.M. Alexanyan

A.V.Vishnevsky Institute of Surgery, RAMS

Medical history of 68-years-old man with clinical manifestations of atherosclerosis in various vascular pools was described. Asymptomatic vertebrobasilar insufficiency and syndrome of vertebralsubclavian steal were diagnosed in this patient. Prosthetics of brachiocephalic trunk and the classical right carotid endarterectomy were performed to prevent cerebral stroke. Repeated ultrasound examination after 8 months revealed satisfactory results of surgical treatment.

UPON POSSIBLE CAUSES OF DEVELOPMENT OF ACHE SYNDROME AT TERMINAL STAGE OF GLAUCOMA

A.P. Ermolaev

Scientific Institute of Ophtalmological Diseases

The reason for appearance and development of the ache syndrome in cases of terminal stage of glaucoma may be the gradient of the concentration of osmotic active substances between blood and inside liquids of eyeball. In article were described 2 patients with terminal stage of chronic renal failure, each of them had aching neovascular glaucoma at terminal stage. Both of them had hemodialysis 3 times a week. During the process of hemodialysis strong increasing pain appeared in the mean eyes of both patients, after the hemodialysis ache faded. Such situation repeated at every following hemodialysis procedure. The author studied concentration of urea nitrogen in vitreous, taken during special anti-glaucoma surgery and the concentration of urea nitrogen in blood, taken before hemodialisys procedure and during the anti-glaucoma surgery. Concentration of urea nitrogen in vitreous before hemodialisys was lower then in blood, while after the procedure of hemodialisys it exceeded its concentration in blood. Supposedly the gradient concentration of urea was the reason for osmotically conditioned tension in walls of ciliary processes, and nociceptors inside.

INTEGRATED APPROACH TO MANAGEMENT OF HEALTH CARE QUALITY

À.Ì. Lukashev

Municipal Clinical Hospital ¹ 60, Moscow

Various aspects of management of health care quality including medical and industrial activity, as well as economic efficiency of qualitative health care were reviewed.

APPLICATION OF THROMBOLYTIC THERAPY IN SENILE PATIENTS WITH ACUTE CORONARY SYNDROME AND ST SEGMENT ELEVATION

A.Yu. Korkina, S.G. Kalinina, Ya.L. Gabinsky,

M.S. Freidlin

Ural State Medical Academy,

Ural Institute of Cardiology, Yekaterinburg

In order to assess complications of thrombolytic therapy, its effectiveness according to the ECG to compare mortality after and without thrombolytic therapy in middle-aged, elderly and senile patients with acute coronary syndrome and ST segment elevation we carried out a retrospective analysis of 881 case histories. We found out that hemorrhagic complications were significantly more likely in senile patients (ð < 0.001), and heart rhythm disturbances were less likely in them than in other age groups. The effectiveness of thrombolytic therapy in senile patients was lower than those of mature age (ð < 0.05) and did not differ from older patients (ð > 0.05). Mortality in its application was significantly lower than without it in elderly and mid- dle-aged patients (ð < 0.05), and it did not significantly differ in senile patients (ð > 0.05).

ПЕРЕДОВАЯ СТАТЬЯ

ТРАНЗИТОРНАЯ ИШЕМИЧЕСКАЯ АТАКА И ГИПЕРТОНИЧЕСКИЙ КРИЗ

В.А. Парфенов, С.К. Рагимов, Т.Г. Фатеева . . . . . . . . . 3

ОРИГИНАЛЬНЫЕ СТАТЬИ

КОМПЛЕКСОНЫ И ГЕПАРИН В КОРРЕКЦИИ НЕЙРОПСИХОЛОГИЧЕСКИХ НАРУШЕНИЙ ПРИ ДИСЦИРКУЛЯТОРНОЙ ЭНЦЕФАЛОПАТИИ

А.Н. Селезнев, И.Д. Стулин, Н.В. Шелестина, А.А. Савин, Г.Н. Змиевский, Л.А. Савин,

Р.К. Шитхкеримов . . . . . . . . . . . . . . . . . . . . . . . . . 13

ВЛИЯНИЕ КАВИНТОНА ФОРТЕ И ПИКАМИЛОНА НА КОГНИТИВНЫЕ РАССТРОЙСТВА У БОЛЬНЫХ ДИСЦИРКУЛЯТОРНОЙ ЭНЦЕФАЛОПАТИЕЙ

В.Б. Ласков, С.В. Поветкин, Е.В. Чернышков. . . . . . . 17

МУЛЬТИСПИРАЛЬНАЯ КОМПЪЮТЕРНАЯ ТОМОГРАФИЯ В ДИАГНОСТИКЕ СОСУДИСТЫХ УМЕРЕННЫХ КОГНИТИВНЫХ НАРУШЕНИЙ

С.Г. Бугрова . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

КОРРЕКЦИЯ ХОЛИНЕРГИЧЕСКОГО ДЕФИЦИТА У ПАЦИЕНТОВ С СОСУДИСТОЙ ДЕМЕНЦИЕЙ

О.И. Мохова . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

МАГНИТНО-РЕЗОНАНСНАЯ ТОМОГРАФИЯ В ДИАГНОСТИКЕ КОГНИТИВНЫХ РАССТРОЙСТВ

ПРИ ДИСЦИРКУЛЯТОРНОЙ ЭНЦЕФАЛОПАТИИ

С.Г. Бугрова . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

СТРУКТУРНЫЕ ОСОБЕННОСТИ ТРЕВОЖНЫХ СОСТОЯНИЙ У ПОЖИЛЫХ, СТРАДАЮЩИХ СЛАБОУМИЕМ

О.Р. Смирнов . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

АКЦЕНТУАЦИЯ СВОЙСТВ ТЕМПЕРАМЕНТА КАК ФАКТОР РИСКА КОГНИТИВНЫХ РАССТРОЙСТВ ПРИ АТЕРОСКЛЕРОТИЧЕСКОЙ ДИСЦИРКУЛЯТОРНОЙ ЭНЦЕФАЛОПАТИИ

В.Б. Ласков, Ю.В. Енютина, В.В. Плотников . . . . . . . 36

EDITORIAL

TRANSIENT ISCHEMIC ATTACK

AND HYPERTENSIVE CRISIS

V.A. Parfenov, S.K. Ragimov, T.G. Fateyeva . . . . . . .3

ORIGINAL ARTICLES

CHELATING AND HEPARIN IN CORRECTION OF NEUROPSYCHOLOGICAL DISORDERS

IN DYSCIRCULATORY

À.N. Seleznev, I.D. Stulin, N.V. Shelestina, À.À. Savin, G.N. Zmievski, L.À. Savin,

R.Ê. Shitkherimov . . . . . . . . . . . . . . . . . . . . . . . 13

THE INFLUENCE OF CAVINTON FORTE

AND PICAMILONE NN COGNITIVE DISORDERS IN PATIENTS WITH DYSCIRCULATORY ENCEPHALOPATHY

V.B. Laskov, S.V. Povetkin, Ye.V. Chernyshkov . . . . 17

MULTISLICE COMPUTED TOMOGRAPHY

IN THE DIAGNOSIS OF MODERATE VASCULAR COGNITIVE IMPAIRMENT

S.G. Bugrova . . . . . . . . . . . . . . . . . . . . . . . . . . 22

REMINYL (GALANTAMINE) IN VASCULAR DEMENTIA

O.I. Mokhova . . . . . . . . . . . . . . . . . . . . . . . . . . 25

MAGNETIC RESONANCE IMAGING IN DIAGNOSTICS OF COGNITIVE DISORDERS IN DYSCIRCULATORY ENCEPHALOPATHY

S.G. Bugrova . . . . . . . . . . . . . . . . . . . . . . . . . . 29

STRUCTURAL FEATURES ANXIETY

IN THE ELDERLY PATIENTS

WITH DEMENTIA

O.R. Smirnov . . . . . . . . . . . . . . . . . . . . . . . . . . 32

ACCENTUAL PROPERTIES OF TEMPERAMENT AS A RISK FACTOR OF COGNITIVE DISORDERS IN ATHEROSCLEROTIC DYSCIRCULATORY ENCEPHALOPATHY

V.B. Laskov, Yu.V. Enjutina, V.V. Plotnikov . . . . . . 36

ОСОБЕННОСТИ КИСЛОРОДНОГО ОБЕСПЕЧЕНИЯ ГОЛОВНОГО МОЗГА У ПОЖИЛЫХ ПАЦИЕНТОВ С ИШЕМИЧЕСКОЙ БОЛЕЗНЬЮ СЕРДЦА

Е.Н. Левичева, И.Ю. Логинова, Г.Н. Окунева, В.Г. Постнов, Т.В. Третякова. . . . . . . . . . . . . . . . . . 41

ОБЗОР

ФАРМАКОТЕРАПИЯ ЦЕРЕБРОВАСКУЛЯРНОГО АТЕРОТРОМБОЗА

Е.В. Портнягина, А.Ф. Портнягин . . . . . . . . . . . . . . 46

В ПОМОЩЬ ПРАКТИЧЕСКОМУ ВРАЧУ

МАСКИ ИШЕМИЧЕСКОГО ИНСУЛЬТА

М.М. Воронцов, С.Е. Хатькова, В.А. Парфенов . . . . . . 55

ГЕРИАТРИЧЕСКИЕ ОСОБЕННОСТИ КОГНИТИВНЫХ РАССТРОЙСТВ ПРИ ЦЕРЕБРАЛЬНОМ ИНСУЛЬТЕ

Т.Т. Киспаева . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60

КЛИНИЧЕСКИЙ РАЗБОР

БЕССИМПТОМНАЯ ВЕРТЕБРОБАЗИЛЯРНАЯ НЕДОСТАТОЧНОСТЬ

С.К. Волков. А.Е. Зотиков, В.М. Алексанян . . . . . . . . 64

ПРИЧИНЫ БОЛЕВОГО СИНДРОМА ПРИ ТЕРМИНАЛЬНОЙ СТАДИИ ГЛАУКОМЫ

А.П. Ермолаев . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68

СРОЧНО В НОМЕР

КОМПЛЕКСНЫЙ ПОДХОД К УПРАВЛЕНИЮ КАЧЕСТВОМ МЕДИЦИНСКОЙ ПОМОЩИ

А.М. Лукашев . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72

ПРИМЕНЕНИЕ ТРОМБОЛИТИЧЕСКОЙ ТЕРАПИИ У ПАЦИЕНТОВ СТАРЧЕСКОГО ВОЗРАСТА

ÑОСТРЫМ К ОРОНАРНЫМ СИНДРОМОМ

ÑПОДЪЕМОМ СЕГМЕНТА ST

А.Ю. Коркина, С.Г. Калинина, Я.Л. Габинский, М.С. Фрейдлин . . . . . . . . . . . . . . . . . . . . . . . . . . . 77

SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80

FEATURES OF THE OXYGEN SUPPLY OF BRAIN IN ELDERLY PATIENTS WITH CORONARY HEART DISEASE

Ye.N. Levicheva, I.Yu. Loginova, G.N. Okuneva,

V.G. Postnov, T.V. Tretyakova . . . . . . . . . . . . . . . 41

REVIEW

PHARMACOTHERAPY OF CEREBROVASCULAR ATHEROTHROMBOSIS

E.V. Portnyagina, A.F. Portnyagin . . . . . . . . . . . . . 46

PRACTITIONERS ASSISTANCE

MASKS OF ISCHEMIC STROKE

M.M. Vorontsov, S.E. Hatkova, Ì.À. Parfenov. . . . . 55

GERIATRIC FEATURES OF COGNITIVE DISORDERS IIN CEREBRAL STROKE

Ò.Ò. Kispaeva . . . . . . . . . . . . . . . . . . . . . . . . . . 60

CLINICAL REVIEW

ASYMPTOMATIC VERTEBROBASILAR

INSUFFICIENCY

S.Ê. Volkov, À.Å. Zotikov, Â.Ì. Alexanyan . . . . . . . 64

UPON POSSIBLE CAUSES OF DEVELOPMENT OF ACHE SYNDROME AT TERMINAL STAGE OF GLAUCOMA

A.P. Ermolaev. . . . . . . . . . . . . . . . . . . . . . . . . . . . 68

URGENT ISSUE

CAUSES OF PAIN IN THE TERMINAL STAGE OF GLAUCOMA INTEGRATED APPROACH

TO MANAGEMENT OF HEALTH CARE QUALITY

À.Ì. Lukashev . . . . . . . . . . . . . . . . . . . . . . . . . 72

APPLICATION OF THROMBOLYTIC THERAPY IN SENILE PATIENTS WITH ACUTE CORONARY SYNDROME AND ST SEGMENT ELEVATION

A.Yu. Korkina, S.G. Kalinina, Ya.L. Gabinsky,

M.S. Freidlin. . . . . . . . . . . . . . . . . . . . . . . . . . . 77

SUMMARY. . . . . . . . . . . . . . . . . . . . . . . . . . . 80