[Stroke risk stratification in elderly patients with comorbid sarcopenia and atherosclerosis]

OBJECTIVE

The study was to investigate the features of carotid arteries atherosclerosis as the leading risk factor for atherothrombotic stroke in elderly patients depending on the presence of sarcopenia.

MATERIAL AND METHODS

2 groups of patients above the working age were examined: 110 patients with normal muscle mass and 24 suffering sarcopenia. Ultrasound examination of carotid and vertebral arteries extracranial segments was performed with an assessment of atherosclerotic changes severity, atherosclerotic plaques instability, 10-year risk of stroke (according to Framingham risk score) and a 10-year risk of fatal cardiovascular disease (SCORE risk scale).

RESULTS

10-year risk of fatal cardiovascular disease was 3 [2; 5] points for patients without sarcopenia, 3 [2; 3] points for patients with sarcopenia (p=0.81). The 10-year risk of stroke was 16 [12; 18] for patients without sarcopenia, 18 [15; 22] points for patients with sarcopenia (p=0.1). Due to the ultrasound examination data the incidence of carotid arteries atherosclerotic lesions in patients without sarcopenia was 50 (46.3%), in patients with sarcopenia - 18 (75.0%) (p=0.01). Statistically significant (p<0.05) increase in the atherosclerotic plaques instability signs was revealed in patients suffering sarcopenia compared to those without it: heterogeneous echotexture - 66.7% cases versus 38.2% (p=0.01), presence of hypoechoic masses - 41.7% patients vs 12.7% (p=0.02).

CONCLUSION

It is important to take into account not only traditional risk factors in the overall assessment of cardiovascular risk as well as therapeutic and preventive measures planning in elderly patients, but also pay attention to body composition since modern diagnostic systems may be not sensitive enough to identify high-risk patients with comorbid atherosclerosis and sarcopenia.

[Paradoxical air embolism of intracerebral arteries as a complication of tooth extraction]

The article describes the rare clinical case, demonstrating sudden onset of neurological manifestations (seizures and consequent formation of ischemic stroke foci) in a 29 year-old female patient during tooth extraction (right lower third molar) using the high-speed dental drill. Air injection through damaged tissues caused subcutaneous emphysema in the buccal area that caused air embolism. Presence of asymptomatic congenital heart defect in the patient (atrial septal defect) allowed the bubbles of air to move paradoxically from right to left with consequent embolization of small cerebral arteries. Treatment in specialized department was successful and had beneficial effect on patient's condition.

Ultrasound assessment of muscle mass in the diagnosis of sarcopenia in cardiovascular patients

Aim. To study the advantages of ultrasound versus anthropometric assessment of muscle mass for early diagnosis of sarcopenia in patients >45 years of age.

Material and methods. The study included 79 patients aged 4589 years with coronary artery disease (CAD), hypertension, type 2 diabetes, heart failure, class 1-3 obesity. Diagnosis of hypertension was carried out according to the European (2018) and Russian (2019) guidelines; CAD — according to Russian Society of Cardiology (2020) guidelines. Sarcopenia was diagnosed according to 2010 European Working Group on Sarcopenia in Older People (EWGSOP) criteria and 2018 EWGSOP2 guidelines. Muscle mass (MM) was determined by two methods: 1 — by measuring the rectus abdominis muscle (RAM) thickness using the ultrasound; 2 — by measuring the arm and lower leg circumference. Muscle strength was determined by wrist dynamometer. Muscle function was assessed using the 4-m gait speed test.

Results. The study showed that in patients aged >45 years admitted to the emergency cardiology department, the body mass index exceeded 25 kg/m2 in 88,6% of cases. The incidence of sarcopenia of varying severity was 55,7% (n=44). The differences in RAM thickness, arm and lower leg circumference between the groups of patients with/without sarcopenia were significant (p<0,001), but were less than the threshold only for RAM thickness. RAM thickness levels progressively decreased with increasing severity of sarcopenia and significantly differed at all stages compared to patients without sarcopenia (p<0,001), regardless of body mass index. A decrease in lower leg circumference below the threshold values determining a MM decrease was observed only in severe sarcopenia, and arm circumference — in both men and women only in severe sarcopenia. There were no significant differences for arm and lower leg circumference depending on sarcopenia stages in overweight and obese patients.

Conclusion. MM assessment by measuring RAM thickness with ultrasound in comparison with the anthropometric method makes it possible to diagnose sarcopenia in patients >45 years of age with cardiovascular diseases and obesity at earlier stages and to promptly recommend preventive measures.

[Surgical treatment results of metastatic spine disease with using minimally invasive technologies, including 3D video endoscopic technologies]

THE AIM OF THE STUDY

Was to evaluate the results of surgical treatment of patients with metastatic lesions of the spine using 3-D video endoscopic technologies.

MATERIAL AND METHODS

We analysed the results of surgical treatment of 33 patients with metastatic lesions of the thoracic spine using a 3D video-assisted thoracoscopic intervention that was performed from November 2017 to December 2019. When examining patients, the following were used: X-ray of the spine, spiral computed tomography (CT), magnetic resonance imaging (MRI), as well as the SINS, Bilsky, Karnovsky, Tokuhashi, Frankel, SF-36 and VAS scales.

RESULTS

The actual life expectancy of the patients completely coincided with the predicted one according to the Tokuhashi scale. Regression of neurological disorders in the early postoperative period (before discharge from the hospital) was observed in 6% of patients (complete in 3%, partial in 3%). When evaluating the results of treatment 12 months after surgery, regression of neurological symptoms was observed in 19% of patients. At the same time, complete regression of neurological disorders occurred in 10%, partial in 9% of patients. When assessing the quality of life on the SF-36 scale, improvement was observed according to the most of the criteria. Also, in the postoperative period, there was a persistent decrease in the intensity of pain syndrome according to VAS compared with the preoperative level.

CONCLUSION

The use of 3-D video endoscopic technologies in the surgical treatment of patients with metastatic lesions of the spine made it possible to improve the quality of life of patients and reduce the number of complications.

[An analysis of the work of vascular service in Smolensk from 2009 to 2014]

MATERIAL AND METHODS

Report of the regional vascular service center of Smolensk work and work of vascular service of Smolensk region were analyzed. The aim of the study is to analyze work of the vascular service in Smolensk and Smolensk region in 2009-2014.

RESULTS AND CONCLUSION

Mortality and morbidity in patients with cardio-vascular diseases in Smolensk Region are higher than in other regions of Russia. Recently a number of patients hospitalized to vascular service centers are increased. Infectious complications (pneumonia, bedsores, pyoderma) take lead place in mortality. Nowadays it's very important to solve the problem with prophylaxis of infectious complications in patients with acute ischemic stroke, also to solve problem with rehabilitation in patients with mild and severe motor disorders and disorders of praxis, gnosis. Continuous training of doctors and nurses in regional vascular service centers is needed. It will increase quality of medical service and improve rehabilitation prognosis in patients with ischemic stroke.