Vol 43, No 4 (2024)

BACKGROUND: Taking into account the increasing number of armed conflicts, the number of combat head traumatic injuries and their consequences, which are faced not only by military doctors, but also by civilian healthcare, is thereof increasing.

AIM: The purpose of this article is to focus the attention of practicing neurologists and neurosurgeons to the modern principles of diagnostic and treatment of post-traumatic epileptic seizures after high-energy combat traumatic brain injury of various severity.

MATERIALS AND METHODS: The article presents the discussion of the clinical application of a number of theoretical concepts, definitions and recommendations used in cases to epileptic seizures after trauma and post-traumatic epilepsy. A prospective analysis of 224 patients with severe combat traumatic brain injury is presented. To evaluate different approaches to preventive therapy of epileptic seizures, the entire cohort of patients was divided into two groups: the first group (n = 122, 54.5% of patients) — without prophylactic use of antiepileptic drugs; the second group (n = 102, 45.5% of patients) — with prophylactic use of antiepileptic drugs. All patients underwent EEG, CT of the brain, and MRI of the brain in the absence of metal fragments in the body. The follow-up period was 12–18 months. Data from 79 patients with concussion in the structure of mine-blast injury were analyzed separately.

RESULTS: The analysis of the incidence of early and late acute post-traumatic seizures is carried out, various approaches to their treatment are discussed, depending on the clinical and diagnostic findings. The historical aspect of comparing the incidence of post-traumatic epilepsy in major wars of the twentieth century and current armed conflicts is touched upon, taking into account the contemporary approaches — the availability of specialized medical care, the possibility of current methods of examination and therapy.

CONCLUSION: The results obtained in the work provide grounds for revising the strategy of prophylactic administration of antiepileptic drugs to patients with severe head injury in modern conditions of providing specialized care.

BACKGROUND: Diffuse gliomas of the brain represent a heterogeneous group, which differs in age of the disease onset, histologic characteristics, tumor grade, molecular genetic markers and prognosis.

AIM: of the present study is to identify the factors, which affect the duration of the relapse-free period and life expectancy in patients with diffuse brain gliomas, based on a comprehensive analysis of clinical syndromes and symptoms.

MATERIALS AND METHODS: The study was carried out at the Departments of Neurosurgery and Nerve Diseases of the S.M. Kirov Military Medical Academy (Saint Petersburg, Russia). It included 390 in-patients with diffuse brain gliomas who underwent treatment over the periods of 2014–2022 and 2004–2006. Age at time of diagnosis was 45.26 ± 15.72 years old. The study included 218 (55.9%) male and 172 (44.1%) female patients. It was a single-centre prospective study.

RESULTS: of the author’s research. Favourable demographic factors include the age range of 18–39 (relapse-free period duration p < 0.01, life expectancy p < 0.001) and female sex (relapse-free period p = 0.02, life expectancy p = 0.03). Prognostically favourable clinical manifestations include epileptic seizures before surgery (relapse-free period p < 0.01, life expectancy p < 0.02); unfavourable clinical manifestations are pyramidal syndrome (relapse-free period p < 0.01, life expectancy p < 0.001), sensitive disorders (relapse-free period p = 0.045–0.12, life expectancy p = 0.09–0.17), speech pathology (relapse-free period p < 0.02, life expectancy p = 0.02–0.12) and cerebellar syndrome (relapse-free period p < 0.02, life expectancy p < 0.001). Clinical signs such as headache, nausea and vomiting, asthenia, diffuse neurological symptoms, craniocerebral nerve involvement and visual impairment do not affect (p > 0.05) the outcomes of the patients with diffuse brain gliomas.

CONCLUSION: Thus, favourable demographic prognostic factors include female sex and age range of 18–39, favourable clinical prognostic factors include epileptic seizures before surgery. Unfavourable clinical prognostic factors include presence of motor, sensory disorders, speech impairment and cerebellar syndrome.

BACKGROUND: Dementia is considered one of the most actual medical problems of our time, being one of the main causes of disability among the elderly, and its prevalence will only increase in the coming years. The first place among conditions leading to dementia is given to Alzheimer’s disease (up to 70%). The effectiveness of Alzheimer’s disease therapy largely depends on the timeliness of diagnosis, which leads to the need to search for diagnostic markers that allow to detect the disease at the earliest stages.

AIM: To evaluate the possibilities of using ¹⁸F-FDG PET for the early diagnosis of Alzheimer’s disease.

MATERIALS AND METHODS: Cerebral metabolism was assessed using positron emission tomography with ¹⁸F-FDG. A total of 183 patients were divided into groups depending on their diagnosis and the severity of cognitive impairment.

RESULTS: A characteristic pattern of cerebral metabolic disorders has been established in patients with Alzheimer’s disease. It can be detected in the early pre-dementia stages and has developmental features as the disease progresses. The pattern was characterized by bilateral hypometabolism in the parietal and temporal cortex with a predominance in its mediobasal sections. An important marker of the development of the neurodegenerative process was a metabolic disorder of the cingulate gyrus, the posterior sections of which are affected already at the earliest stages of the disease, while the involvement of its anterior sections reflects the transition to the stage of severe dementia. Described metabolic disorders prevailed in the dominant (left) brain hemisphere at all stages of the disease.

CONCLUSION: Currently ¹⁸F-FDG PET can be considered the most informative of the available methods for the early diagnosis of Alzheimer’s disease which have a fairly high degree of accuracy.

BACKGROUND: Currently, there is an increasing expansion of Russia’s areas of interest in the Arctic region with an increase in the number of specialists of various profiles working in high and ultra-high latitudes on a long-term basis. Modern technologies effectively solve the problems of improving everyday life, reducing the influence of negative factors of the North, which makes it possible to increase the number of employees and expand the range of tasks they perform. At the same time, in these conditions, a person is constantly exposed to negative factors of the North, which affect both the effectiveness of his professional activity and his state of health. Negative factors are also seasonal in nature, associated with the peculiarities and change of the periods Polar Day — Polar Night. One of these important factors is sleep disorders, which have a negative impact on the effectiveness of professional activities, short-term and long-term changes in health. Most studies have focused on sleep disturbances in high latitude environments during the Polar Night period.

AIM: The aim of the work was to study the features of sleep disorders in people working in ultra-high latitudes of the Arctic region during the Polar Day and to develop methods for their correction.

MATERIALS AND METHODS: As part of the goal of the study, 208 people working on a rotational basis on the island of Alexandra Land of the Franz Josef Land archipelago during the Polar Day were examined. The study was conducted through an extended survey on sleep quality and the use of a questionnaire to assess the severity of insomnia and the daytime sleepiness scale.

RESULTS: According to the results of the examination, typical sleep disturbances for the polar day period were: difficulty falling asleep, difficulty maintaining sleep (superficial sleep with frequent awakenings), early awakening, daytime (afternoon) sleepiness. At the same time, most of the subjects noted the seasonality of these complaints associated with the Polar Day period. It was revealed that the most pronounced and persistent sleep disorders are detected in persons during their stay in the Arctic zone from 1 to 3 years and after 10 years of work, which is associated in the first case with the formation of adaptation mechanisms, in the second — with their exhaustion. Factors supporting sleep disorders were identified (social and information deprivation (lack of access to Internet resources, limited communication with the mainland, etc.); physical inactivity; irregular daily shift schedule, the need to perform additional work, monotony of work, exposure to low temperatures).

CONCLUSION: Non-drug correction methods have been proposed that have shown high efficacy.

The development of problems of combat pathology is a constant focus of scientific interests of scientists of the S.M. Kirov Military Medical Academy. With the beginning of a Special military operation, it received a new impetus for development both due to the large clinical material and due to changes in the structure and nature of modern combat pathology. The relevant teams have joined forces to develop the most priority tasks. Based on the analysis of the mortality of wounded on the battlefield, the principles of “tactical medicine” were developed and implemented in practice, aimed at combating the most common causes of death at the pre-hospital stage, and training cycles for instructors for the whole country were organized in the established Center for Tactical Medicine. Principles of anesthesia and shock control at the stages of medical evacuation have been developed. Based on the study of the structure of combat surgical pathology, the tactics of screening diagnosis of hidden injuries during medical triage are proposed, the principles of staged surgical treatment of wounds (the principle of damage control) are clarified, an integrated system of treatment of wounded with injuries of the musculoskeletal system is developed. At the hospital stage, improved methods for the prevention of thromboembolic complications, treatment of phantom pain syndrome, and stress-associated mental disorders are proposed. The spectrum of wound infection pathogens and existing antibiotic resistance has been studied, new wound dressings have been developed. A prototype of the system of professional psychological selection and support of operators of unmanned aerial vehicles has been formed. Guidelines on military field surgery and military field therapy have been developed, more than 50 methodological recommendations on the most in-demand issues of organization and provision of medical care. Thus, in a little more than 900 days, the scientists of the S.M. Kirov Military Medical Academy has carried out a huge amount of work only in scientific terms, introducing the results into the practice of military doctors. This makes it possible to achieve the best performance indicators of the medical service of the Armed Forces of the Russian Federation in comparison with previous conflicts.

Fragile X-associated tremor/ataxia syndrome (FXTAS) is a neurodegenerative disease recently described in the literature with a low percentage of detectability in patients due to insufficient awareness of doctors. The clinical picture is characterized by high phenotypic variability and coincidence of symptoms with other, more well-known motor disorders, in connection with which patients are observed for a long time with erroneous diagnoses. The issue of the differential diagnosis fragile X-associated tremor/ataxia syndrome with essential tremor, Parkinson’s disease, multiple system atrophy, spinocerebellar ataxia and progressive supranuclear paralysis is highlighted separately. In order to demonstrate the complexity of the diagnosis of this disease, a description of a case of genetically confirmed case of genetically confirmed fragile X-associated tremor/ataxia syndrome is presented. The described clinical case is represented by a combination of asymmetric disabling postural kinetic tremor of the hands, minor resting tremor, moderate cerebellar ataxia, asymmetric moderate dopa-responsive parkinsonism syndrome, mild cognitive impairment and psychotic symptoms. Not only the clinical picture of the disease is described in detail, but also the hereditary history of the patient: the results of a genetic study of a daughter premutation carriers of the FMR1 gene and a grandson suffering from Martin–Bell syndrome. A special feature of the clinical case is the long-term erroneous observation of a patient diagnosed with Parkinson’s disease, as well as high-dose therapy with levodopa/carbidopa 250 mg + 25 mg (up to 6 tablets per day). When studying the available domestic literature, the previously described cases of fragile X-associated tremor/ataxia syndrome were not found.

The article presents the history of the development of traditional oriental medicine in Russia and USSR in the 20^th century. Information about Eastern medicine obtained in the 20^th century thanks to the employees and doctors of the Russian Ecclesiastical Mission in Beijing has been repeatedly analyzed and rethought. A great contribution to the understanding of Eastern methods of treatment was the translation of Zhud-shi made by P.A. Badmaev. At the beginning of the 20^th century, V.V. Korsakov and Ya.A. Violin defended dissertations on Chinese medicine at the Military Medical Academy. In 1948, the outstanding Soviet scientist E.S. Vyazmensky created and defended his dissertation “Chinese Medicine. Its History and Theory in a Brief Essay.” This fundamental work influenced the further development of oriental medicine in the USSR. Having reworked it, the founder of the Gorky School of Reflexology V.G. Vogralik published the book “Essays on Chinese Medicine” by two authors. A contribution to the popularization of Eastern methods of treatment and disease prevention was made by the physician D.N. Stoyanovsky. Close cooperation Working partnership between the Soviet Union and the People’s Republic of China in the 1950s contributed to the development of traditional oriental medicine in the USSR. Doctors who studied the theory and practice of zhen-jiu in Beijing became leading researchers and founders of schools of acupuncture in their homeland. The foundation of the Leningrad School of Reflexology was laid by E.D. Tykochinskaya. Her endeavors were continued by A.T. Kachan, N.N. Bogdanov at the Leningrad State Institute for Advanced Medical Studies; V.V. Shapkin, M.M. Odinak — at the S.M. Kirov Military Medical Academy; R.A. Aleksandrova, Yu.D. Ignatov, Yu.N. Vasiliev, D.A. Dubrovin — at the 1^st Leningrad Medical Institute; G.A. Suslova — at the Leningrad Pediatric Medical Institute. In 1997, reflexology was approved as a separate specialty by order of the Russian Ministry of Health.