[Management of urological patients with HIV infection].

The analysis of urological care for HIV infected patients treated in Moscow city clinical hospital N 47 covers 12-year trends in hospitalization of HIV-infected urological patients, their nosological distribution, statistics of surgical outcomes. The highest efficacy of empiric antibacterial therapy of acute pyelonephritis in HIV-infected patients was seen in combined administration of fluorofloxacin of the second generation (ofloxacin) and nitroimidasol (metronidasol). Specific features of pharmacokinetics and interaction of antiretroviral drugs with medicines used in urological practice are analysed.

[Lantox treatment of neurogenic dysfunction of the bladder].

We studied correction of micturition disorders in 9 patients with neurogenic dysfunction of the bladder resistant to conservative treatment. Four patients had neurogenic detrusor hyperactivity and 5 patients had detrusor-sphincter dyssynergia. Injections of botulinic toxin preparation (lantox) were made in the wall of the bladder under endoscopic control in detrusor neurogenic hyperactivity. Women with detrusor-sphincter dyssynergia received transperineal injections of lantox in the region of external urethral sphincter. Men received botulinic toxin directly into the region of external urethral sphincter in urethroscopy. Positive results were achieved in all the cases confirming high efficacy of the method.

[Using energetic Doppler-angiography in combined diagnostics of prostatic abscess].

Diagnostic possibilities of conventional clinical-laboratory, physical methods, seroscale echography and energetic dopplerangiography (EDA) were compared in 32 patients with prostatic abscess (PA). Nonspecific symptoms hamper conventional PA diagnosis. PA is detected, as a rule, at transrectal ultrasonic investigation (TUI) which is effective in formed PA (sensitivity 100%) but is low effective in early PA (sensitivity 50%). Minimal size of PA detectable by TUI is 7 mm (mean 12 +/- 1.2 mm). EDA improves diagnostic potential of TUI in infiltrative PA (sensitivity 91.7%). In established PA, EDA confirms TUI findings. Transabdominal ultrasonography has insufficient resolution and must be used for PA screening.

[Upper urinary tract hypertrophy of the solitary kidney]. / Gipertrofiia verkhnikh mochevykh putei edinstvennoi pochki.

17 dogs were examined 1 and 3 months, 1-1.5 years after unilateral nephrectomy. It was found that compensatory hypertrophy develops not only in the parenchyma of the remaining kidney but in the upper urinary tracts as well. 1 month after the nephrectomy ureteral activity for urine evacuation enhanced as compared to its preoperative activity. 3 months and 1-1.5 years after the nephrectomy ureteral performance remained elevated. High performance was supported due to increased amplitude of the contractions and their prolongation. Frequency of the contractions reduced. Basal and peristaltic pressure in the ureter, as a rule, rose. Diuretic lazix load 3 months after nephrectomy and more led to higher elevation of the intraureteral pressure. Ureteral wall lock in contraction promoting active urinary transport was observed whereas this locking mechanism before nephrectomy was decompensated even in lower intraureteral pressure. Ureteral hypertrophy was followed by negative effects such as defective generation and conduction of excitation through the ureter, higher incidence of endogenous infection in the urinary tracts.

[The role of dynamic observation in the prevention of recurrences of stone formation]. / Rol' dinamicheskogo nabliudeniia v profilaktike retsidivov kamneobrazovaniia.

26 patients with recurrent and non-recurrent urolithiasis treated surgically or by lithotripsy and 14 patients free of urolithiasis were examined biochemically by 9 metabolic blood and urine parameters and using Litos test proposed by urologists of the Moscow Regional Research Clinical Institute for detecting lithogenesis in the kidneys. The comparison of the findings obtained with biochemical and Litos tests showed that these tests are mutually complementary. Monitoring of urolithiasis patients should be complex, i.e. including biochemical examination for disbolism and urinalysis by means of Litos test.

[The DIC syndrome as a complication of the surgical treatment of urolithiasis in urology patients]. / DVS-sindrom kak oslozhnenie khirurgicheskogo lecheniia mochekamennoi bolezni u urologicheskikh bol'nykh.

The authors discuss the causes of the DIC syndrome in urological patients operated on for urolithiasis. They enumerate the factors predisposing to the DIC syndrome and causing it. The predisposing factors are chronic renal insufficiency and metabolic disorders caused by azotemia, infectious inflammatory complications of urolithiasis, and intoxication. The causes of the disease are massive blood loss involving disorders of the hemodynamics and blood rheology, bacterial shock, and other stress conditions. A protocol for treating this complication and validation of pathogenetic therapy is offered.

[The correlations of the basic indices of central and renal hemodynamics in patients with a single allograft kidney]. / Vzaimootnosheniia osnovnykh pokazatelei tsentral'noi i pochechnoi gemodinamiki u bol'nykh s edinstvennoi allotransplantirovannoi pochkoi.

A simultaneous assessment of relationship of central and renal hemodynamic parameters has been performed in patients with a renal transplant of different functional performance. Radionuclide routine techniques of one-passage radiocardiography and indirect renal angiography in single bolus intravenous introduction of radiopharmaceutical were used. Three groups of patients were identified according to functional capacity of the renal transplant: 15 patients with satisfactory function of the transplant for 85 days on the average (group 1); 8 patients with unstable function of the transplant for 155 days (group 2); 7 patients with poor function of the transplant for 375 days on the average. The transplant's function was judged by the routine clinical data including blood urea, arterial pressure, heart rate, diuresis, the patients' complaints. Basic parameters of central hemodynamics appeared elevated in all the three groups, the differences being statistically insignificant. However, total peripheral vascular resistance was growing with deterioration of the renal function. Renal hemodynamics worsened with the decline of the transplant's function. Investigation of the relationships between total peripheral vascular resistance (TPVR) and renal vascular resistance (RVR) showed that between the groups there was a significant difference by RVR/TPVR (7.0, 9.0 and 14.0 for groups 1, 2 and 3, respectively), the higher value being the indication of increasing uremic intoxication and functional decline. A simultaneous rise of RVR and TPVR in persistent ratio 7-8 was associated with acute failure of the function in 7-14 days (3 cases). The results of the trial support the validity of simultaneous assessment of central and renal hemodynamics for specifying function of the renal transplant and cardiovascular system in patients with terminal renal failure and transplanted kidney as well as to define the risk group of the transplant's functional failure 7-14 days before manifestation of clinical symptoms.

[The comparative characteristics of the effect of continuous ischemia and ischemia with periodic reperfusions on the function and metabolic indices of the rabbit kidney]. / Sravnitel'naia kharakteristika vliianiia nepreryvnoi ishemii i ishemii s periodicheskimi reperfuziiami na funktsiiu i nekotorye pokazateli metabolizma pochek krolika.

Continuous 40-min ischemia and ischemia with reperfusion (10 min of ischemia and 10 min of reperfusion) induced by ligation of the vascular kidney crus were compared in experiments on 17 New Zealand rabbits. Both in continuous and interrupted (in period 4) ischemia resulted in the growth of pO2 cortical layer which is likely to be due to reduced oxygen utilization of the cells caused by metabolic and renal function disorders. Examination of lipid peroxidation activity determined similar activation of this process in both ischemic variants. In spite of the fact that both continuous and interrupted ischemias induced similar hyperoxygenation of the cortical substance and the same activation of lipid peroxidation, functional damage was less severe in experiments with interrupted ischemia.

[The effect of endovascular helium-neon laser therapy on the immune status of patients with acute calculous pyelonephritis]. / Vliianie éndovaskuliarnoi gelii-neonovoi lazernoi terapii na immunnyi status bol'nykh ostrym kal'kuleznym pielonefritom.

Cellular immunity was assessed in 48 patients with acute calculous pyelonephritis exposed to intravenous He-Ne laser therapy. It was found that endovascular He-Ne laser therapy in the study regimens corrects immunological abnormalities arising in acute calculous pyelonephritis.

[The radionuclide assessment of the central hemodynamic indices in patients with urolithiasis, arterial hypertension and varicocele]. / Radionuklidnaia otsenka pokazatelei tsentral'noi gemodinamiku u bol'nykh mochekamennoi bolezn'iu, arterial'noi gipertenziei i varikotsele.

Basic parameters of central and intracardiac hemodynamics were studied in 49 urological patients 24 of which with urolithiasis entered group I, 13 with hypertension-group II and 12 with varicocele-group III. The patients' age averaged 46.4, 41.6 and 28.6 years, respectively. The data were provided by routine clinical and laboratory examinations, ECG, one-passage radionuclide cardiography with 132I-albumin using a radiocirculographer of Hungarian manufacture and radiocardioanalyzer RKAZ-01 made in this country. Neither marked ischemic disturbances of the myocardium nor valvular defects were revealed. Ambiguous group-specific shifts presented in central and intracardiac hemodynamics. Total peripheral vascular resistance exhibited a moderate increase while left ventricular circulation time grew 1.5-2-fold. The greater resistance can be attributed to activation of renin-angiotensin system in prolonged ischemia of renal parenchyma due to nephrolithiasis. Group II patients demonstrated parallel elevation of arterial pressure, peripheral resistance, left ventricular performance and output suggesting myocardial functional stress. In group III there was a rise in blood volume, left ventricular performance and output, cardiac index, stroke volume. This myocardial overloading may result from changes in intravascular volumetric relations characteristic of hypervolemia. These hemodynamic changes reflect adaptation in urological patients and should be accounted for in treatment and operative interventions.

[Ultrasonic study of the parathyroid glands in patients with coralliform nephrolithiasis]. / Ul'trazvukovoe issledovanie okoloshchitovidnykh zhelez u bol'nykh s korallovidnym nefrolitiazom.

Functional activity of the parathyroid glands (PTG) is important for the choice of proper therapeutic policy in patients with dendritic nephrolithiasis. The location of the hyperfunctioning gland (usually adenomatously or hyperplastically changed) is a complicated problem as the dimensions of the gland are extremely small. Ultrasonic investigation of the parathyroid gland area for detection of the enlarged gland is used at the Research Institute of Urology, the RSFSR Ministry of Health. Linear (7.5 mHz) and sector (5 mHz) transducers have been used through the water medium and by the immediate contact with the surface of the patient's neck. A total of 24 subjects were enrolled in the study (13 females and 11 males aged 23-64 years). Enlarged parathyroid glands situated in the lower thyroid lobe (low parathyroid glands) or in the upper medial third of the thyroid lobe (upper parathyroid glands) were recorded in 9 patients and confirmed in the course of surgeries. In one case, the enlarged parathyroid gland was found in the thyroid tissue. Its length varied from 0.6 to 1.5 cm and its thickness, from 0.4 to 0.9 cm. All the glands were echographically evidenced as oval formations with a low-rate echogeneity and clear-cut smooth contours. In 3 cases the site of the gland was confirmed by a selective testing of the neck venous blood for parathyroid hormone. Histological examination of the removed glands revealed that hyperplastic changes were more common than the adenomatous ones.