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Publications
U. Lushchyk
Hemodynamic basis of migraine, convulsive syndromes and vegetovascular
syndrome in children. (summary)
I. Lehkyy, U. Lushchyk
Transcranial dopplerography in differential diagnostics of cerebral
blood flow acute disturbances (summary)
I. Khashcha, L. Tymoshenko, U. Lushchyk
Functional-structural state of fetoplacentar system in pregnant
with iron deficiency anemia (summary)
U. Lushchyk, M. Polishchuk, A. Rudenco
Potentials of ultrasound dopplerography in hemorrhagic insult
process prognosing and in taking operative treatment tactics option
(summary)
G. Hryhorash, U. Lushchyk, P. Nikulnikov
Atherosclerotic discirculatory ecephalopathy patients treatment
tactics (summary)
Lushchyk U.B. Peculiarities of arterial and venous brain circulation
in diagnostics and treatment of cerebrovascular diseases in differently
aged people . - Manuscript.
A competition for the doctoral dissertation on speciality 14.01.15
- nerve diseases / - Kyiv Medical Academy of Post-Graduate Education,
Ministry of Health of Ukraine, Kyiv, 1998.
Resume.
A complex clinical, physiological and instrumental study methodic
to reveal the arterial and venous blood supply disturbances in patients
suffering from CVD. The character of a CVP depends on age-specific
changes of the arterial wall's elasticity, reduction of the linear
arterial and venous circulation rate, disturbances of cerebral veins
and venous brain outflow collectors' tone. The methods of USD, treatment
and rebuilding of arterial and venous cerebral channels in discirculatory
encephalopathy genesis, acute ishemic hemorrhagic and tumorous discirculations
have been approved and tested. The term and estimation of methods
of the arterial and venous cerebral balance as a cause of vascular
and cerebral disturbances and hemodynamically grounded individual
approach to the selection of vasoactive agents have been offered.
Key words: cerebrovascular diseases, cerebral hemodynamics, cerebral
arteries, main head arteries, cerebral veins and sinuses, cerebral
circulation, arterial and venous cerebral balance, arterial and
venous shunting.
Summaries
Hemodynamic basis of migraine,
convulsive syndromes and vegetovascular syndrome in children
The problem of neurotic abnormality, of frequent headaches in children
of different age is an urgent matter and has not been objectivated
in the sphere of infantile neurology. That is why the importance
of instrumental noninvasive diagnostic methods, which are more informative
on the subclinical level of disease, is growing now.
On the basis of The Mother and Child Center 135 children and teenagers
at the age of 3-18 have been examined. The convulsive syndrome(CS)
has been diagnosticated clinically in 52 patients, migraine(M) -
in 9, vegetovascular dystonia (VVD) - in 74. The control group consisted
of 130 healthy children of the same age. All the patients and the
control group have been examined by the methods of Echoencephalography,
Electroencephalography (EEG), Re-encephalography and USVD. For the
USVD we used the ultrasound system SONOLINE - 450 manufactured by
Siemens /Germany/, for the EEG - the equipment Era-9 by Esaote Biomedica
/Italy/. The signs of the venous discirculation, which were designated
moderately in children with VVD and subcompensated in those with
CS and M, dominated almost in all examined patients. Perhaps convulsive
states in children are the clinical symptoms of cerebrum compensative
resources breakdown with the development of hyperemia and compensative
limitation of the arterial blood to the cerebrum and brain edema.
It is USDG that can objectivate hemodynamically patients` complaints,
while EEG evaluates functional brain insufficiency at the preclinical
stage in children with the mentioned above pathology.
Hence, the investigations carried out make it possible to conclude
that USDG allows to prove instrumentally the presence of adn differentiate
by segments venous as well as arterial discirculation in children
with VVD, migraine and some convulsive states.
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Transcranial dopplerography
in differential diagnostics of cerebral blood flow acute disturbances
Lately cerebral blood flow acute disturbances(CBFAD) in young and
middle-aged people has become more frequent. That is why the diagnostic
importance of ultrasound dopplerography(USDG) together with the
computer tomography(CT) rises. It is considered that sufficient
blood flow in the cerebral arteries preservation, compensatory overloading
of venous cerebral bed at the expense of spontaneous drainage of
intracerebral hematoma, the absence of extravasal compression of
cerebral arteries make it possible to recognize USDG-data as confirmation
of positive prognosis of intracerebral hemetoma. Medicamental treatment
in patients with CBFAD may be chosen adequately and its efficiency
may be estimated with the help of USDG. In case of intracerebral
hematoma, labored venous outflow it is necessary first of all to
correct venous cerebral hemodynamics, which allows to abate cerebral
vasospasm. Hemodynamical changes in cerebral blood supply according
to the USDG-data allow to suspect and confirm if needed CT-data
for the subarachnoidal hemorrage, intracerebral hematoma, arterial-venous
malformation, cerebral tumor and change in time a conservative treatment
into an operative one.
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Functional-structural state
of fetoplacentar system in pregnant with iron deficiency anemia
The issue of perinatal fetus protection during the pregnancy has
always been one of the most important problems of modern obstetrics.
The particular attention must be paid in cases of different kinds
of extragenital pathology, which are the reason of mother-placenta-fetus
united system disfunction. Very urgent is the problem of fetoplacentar
insufficiency diagnostics at the early stages, which could give
the possibility to prevent perinatal losses.
During the investigation 118 pregnant with preanemia and anemia
of different stages as well as 115 pregnant of control group were
examined using the methods of ultrasound diagnostics (fetometry,
placentography, estimation of amniotic fluid and umbilical cord,
dopplerography of uterine arteries, umbilical cord arteries and
vein, aorta and internal carotid artery) and the method of phonocardiography.
The results of the investigation gave us a possibility to make preliminary
conclusions: iron deficiency anemia is a pregnancy complication,
which causes early disturbances of fetoplacentar system functional
state, and worsens cardiac activity in fetus. The disturbance of
fetoplacentar blood circulation depends on the anemia degree, its
beginning and duration as well as on repetition factor of previous
pregnances and labors.
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Potentials of ultrasound dopplerography
in hemorrhagic insult process prognosing and in taking operative
treatment tactics option
During the investigation the comparative analysis of clinical-neurological-hemodynamical
and structural changes at the acute period of hemorrhagic insult(HI)
in 56 patients aged 19-59 has been carried out. The majority of
them suffered intracerebral hematomas(ICH). The attention has was
paid mostly to the potential of ultrasound dopplerography in cerebral
blood flow hemodynamical estimation in patients with hemorrhagic
insult.
It was found that the main pathogenetical role in cerebral decompensation
with HI plays parenchymatous hemorrhage and a lesser degree - a
subarachnoidal one.
Intracerebral hematoma causes brain tissue compression. Cerebral
arteries extravasal compression imitates compressed artery vascularisation
zone secondary ischemia. Pathology is intensified by spasm appearing
with subarachnoidal hemorrhage.
Comparatively quick regression of neurological and computer tomography
symptomatology in HI patients has been noticed with the presence
of the following criteria: 1) cerebral venous outflow medium acceleration
location in intracerebral hematoma or in sinus rectus; 2) cerebral
artery compression absence and sufficient blood flow preservation
in basis cerebri arteries.
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Atherosclerotic discirculatory
ecephalopathy patients treatment tactics
The problem of atherosclerotic discirculatory ecephalopathy(ADE)
as a slowly progressing brain blood flow insufficiency with the
development of brain tissue microfocal changes and its function
disturbance followed by the development of cerebral insults is topical
today because of high death-rate and the significant rate of able-bodied
citizens invalidisation.
For taking the adequate cerebrovascular patients treatment option
it is important to know the pathophisiological mechanism of cerebral
discirculation and means of its compensation. Since the operations
on major head artery(MHA) are difficult technically, exspencive
economically and often uncertain in life we are in process of search
of cerebral vessels revascularisation prognosis criteria. While
planning the operation doctor should know the surgical correction
prospects. It is important for the patients` life saving, brain
flow disorders prophylaxis, patients life quality and duration improvement.
For solving these problems the comparative analysis of close and
remote results of concervative and operative treatment in 244 ADE
patients was carried out.
It was found, that the remote effect of operative treatment in ADE
patients was 1.9 times more successful than that of medicamental
one.
The most auspicious prognostically for a surgical correction in
aspect of patients life is ADE of I-II stages. Operative treatment
in ADE patients at III stage is favourable in case that the operation
risks are lower than those of disease progressing.
Indications for operative treatment of the ADE patients with major
head arteries stenosing lesion has been worked out.
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