[Treatment of ureterocele in children].

Twenty six patients (15 children and 11 adults) with ureterocele were treated. Heterotopic ureterocele prevailed over common forms in children while in adults--vice versa (66.7 and 33.3% versus 27.3 and 72.7%, respectively). Recurrences of ureterocele are rather frequent. Modified surgical correction of ureterocele is proposed which consists in intravesical mobilization of ureterocele together with a terminal part of the ureter followed by resection and its transverse re-implantation with antireflux defense. Such therapeutic policy facilitates performance of the operation and enhances reliability of the closing antireflux mechanism. Endoscopic correction of ureterocele with one-stage lithoextraction was made in 7 adult patients who had undergone transverse dissection of ureterocele, in large ureterocele--partial resection of the lower part. The residual upper part operates as a closing valve in filling of the urinary bladder. Long-term results (3-year follow-up maximum) were studied in 23 patients. Dissection of ureterocele with ureterocystoneostomy was associated with recurrences in 37.6% patients. The best results were achieved in plastic modified operations and endoscopic correction of ureterocele. A persistent clinical effect was seen in all the patients.

[Gastrointestinal hormones in the blood serum of patients with chronic renal failure]. / Soderzhanie gastrointestial'nykh gormonov v syvorotke krovi bol'nykh khronocheskoi pochechnoi

Content of gastrointestinal hormones (gastrin, insulin, glucagon, C-peptide), beta2-microglobulin, glomerular filtration rate (GFR) were studied in 65 patients with nephrolithiasis (NL) and in 73 patients with chronic renal failure (CRF). It was found that NL with GFR under 80 ml/min runs with elevated insulin, glucagon and C-peptide while CRF with CRF under 30 ml/min is characterized by aggravated disorders of hormonal homeostasis (gastrin, insulin, glucagons, C-peptide elevation). As gastrointestinal hormones in patients with CRF are high, it is recommended to combine medication with diet containing low amount of carbohydrates easy for digestion which is important in the treatment of CRF.

[Sex correction in testicular feminization syndrome]. / Korrektsiia pola pri sindrome testikuliarnoi feminizatsii.

From 1993 to 2000 the authors observed 10 patients with testicular feminization. In spite of existent highly informative methods, early diagnosis of the genesis of abnormal sexual differentiation is not easy, it requires time. Treatment policy varied with the form of testicular feminization. In a complete form (6 patients), bilateral ventrofixation of the gonads (ovotestis) was made, in incomplete form (4 patients) male gonads were removed with subsequent replacement hormonotherapy. Correction of the external genitalia consisted in amputation of the hypertrophic clitoris with creation of the female-type external genitalia. It is emphasized that in incomplete testicular feminization surgical correction should be started before the appearance of secondary sexual characters to raise effectiveness of hormone treatment in formation of a female genotype.

[Surgical treatment pf vasorenal hypertension complicated by renal failure]. / Khirurgicheskoe lechenie vazorenal'noi gipetenzii, oslozhnennoi pochechnoi nedostatochnost'iu.

28 patients with vasorenal hypertension complicated by renal failure were operated. 20, 7 and 1 patients were in the stages of compensation, subcompensation and decompensation, respectively. Nephrectomy, plastic reconstruction of renal artery, nephropexy, dilation of the renal artery were made. Validity of adrenalectomy is discussed. Good and satisfactory responses were observed in 50 and 35.7% of cases. 14.3% of the patients failed treatment. Poor effect was observed in long-term and severe arterial hypertension and late stages of renal insufficiency.

[Long-term results of plastic surgery in hydronephrosis in children]. / Otdalennye rezul'taty plasticheskikh operatsii pri gidronefroze u detei.

94 children (109 kidneys) with congenital hydronephrosis were treated in 1989-1997. 67 of them underwent 76 plastic operations: Andersen-Hynes operation on the ureteropelvic segment without pelvic resection (n = 53), antevasal pyelopyelo- and ureteropyeloanastomosis (n = 18), ureteropyelolysis (n = 5). Excellent, good and satisfactory results were obtained in 16.5, 50.6 and 30.4% of cases, respectively. The analysis of changes in the renal-cortical index before and after plastic operation with reference to hydronephrosis stage and form, type of the pelvis evidenced that the best treatment outcomes were achieved in children with open hydronephrosis stage II having extrarenal pelvis. Poor outcomes occurred in closed hydronephrosis stage III and intrarenal pelvis. Renal planimetry, as one of highly informative diagnostic techniques, can be used in assessing results obtained in hydronephrosis treatment.

[Changes in portal and hepatic blood flow in patients with chronic kidney failure as shown by Doppler ultrasonography]. / Izmeneniia portal'nogo i pechenochnogo krovotoka u bol'nykh s khronicheskoi pochechnoi nedostatochnost'iu po dannym dopplersonografii,

45 patients with chronic renal failure (CRF) were examined for blood flow in the portal vein and hepatic artery using impulse dopplerography. In the hepatic artery there was lowering of maximal systolic blood flow, end diastolic blood flow, elevated pulsative index and index of resistance. These changes appeared at early stages of CRF and progressed with its progression.

[Comparative features of antireflux surgery, causes of recurrence of vesicoureteral reflux in children]. / Sravnitel'naia kharakteristika antirefliuksnykh operatsii, prichiny retsidivirovaniia puzyrno-mochetochnikovogo refliuksa u detei.

2560 children with the reflux were observed, 224 of them were operated. Long-term positive results after Koan's operation were noted in 97.7% of the patients. Different plastic operations were assessed, technical operative mistakes analyzed.

[The ultrasonic diagnosis of ureteral stones in children]. / Ul'trazvukovaia diagnostika kamnei mochetochnika u detei.

Ultrasonography (USG) was performed in 117 children aged 8 months-14 years with ureterolithiasis. X-ray and ultrasonic evidence was compared for the upper, middle and low parts of the ureter. USG proved preferable for imaging of the upper and low ureter, x-ray negative concrements, in loss of renal function, while x-ray was much more informative for visualizing middle part of the ureter. Thus, USG is thought highly effective in diagnosis of ureterolithiasis in children.

[Changes in myocardial hemodynamics and contractile function in patients under surgical treatment for prostatic adenoma]. / Izmeneniia gemodinamiki i sokratitel'noi funktsii miokarda u bol'nykh pri operativnom lechenii adenomy predstatitel'noi zhelezy.

Hemodynamics and left ventricular myocardial contractility in 170 patients who underwent surgery of prostatic adenoma were examined in preoperative period and 16 days after single-stage transvesical adenomectomy. The age of the patients varied from 52 to 85 years. Echocardiography and the dilution method were used for the evaluation. The increase of end-diastolic and end-systolic volumes, stroke volume, cardiac index, was registered. The combined pharmacological treatment made it possible to decrease the number of operative and postoperative cardiovascular complications.

[The possibility of predicting the hypotensive effect of the surgical treatment of nephrogenic hypertension]. / Vozmozhnost' prognozirovaniia gipotenzivnogo éffekta khirurgicheskogo lecheniia nefrogennoi gipertenzii.

An acute captopril test with a repeated dynamic renoscintigraphy was made in 27 patients with unilateral diseases of the kidneys complicated by nephrogenic hypertension. The above pharmacotest allows the hypotensive effect of operation to be prognosed by the dynamics of the average arterial pressure, plasma renin and blood aldosterone activity as well as by the dynamics of the rate of glomerular filtration and efficient renal plasma flow in the contralateral kidney.

[Disorders of pulmonary hemodynamics in patients with diabetic nephroangiopathy and its correction with antioxidants]. / Narusheniia legochnoi gemodinamiki u bol'nykh s diabeticheskoi nefroangiopatiei i ikh antioksidantnaia korrektsiia.

Hemodynamic changes of lesser circulation were investigated in 108 patients with diabetic nephroangiopathy. They were also given vitamin E therapy (8 micrograms/kg of body mass) for 2 weeks to correct metabolic derangements and indices of pulmonary hemodynamics. Partial renal function was determined with 131I-hippuran and 99mTc-DTPA renoscintigraphy. Pulmonary hemodynamics was assessed with pulmonary scintigraphy (MAA 99mTc). The results have shown that vascular renal lesions in diabetes mellitus cause hypertension of lesser circulation and disorders in pulmonary microcirculation, and disorders of lipid metabolism and activation of lipid peroxidation (LPO) progress with augmentation of severity of disease. Vitamin E therapy improves pulmonary hemodynamics, lipid metabolism and LPO. Antioxidant correction was most effective at the initial stages of diabetic nephroangiopathy.

[The role of echography in the diagnosis of vesico-ureteral reflux in children]. / Rol' ékhografii v diagnostike puzyrno-mochetochnikovogo refliuksa u detei.

A study was made of alternative potentialities of ultrasonography in the diagnosis of vesicoureteral reflex (VUR) in 137 children (228 kidneys) aged 16 days to 14 years. Routine scanning of the urinary tract was performed; the dynamics of dilatation of the renal pelvis was estimated depending on the degree of the urinary bladder filling and urination; contrast sonography was carried out. Complex ultrasonography was informative in 33% of cases with grade I VUR, in 79% of cases with grade II VUR, and in 100% of cases with grade III-V VUR. It is suggested that in accordance with the ultrasonography data, VUR can be distributed into three main groups.

[A comparative assessment of homeostasis and hemodynamics during the performance of bicarbonate and acetate hemodialysis]. / Sravnitel'naia otsenka gomeostaza i gemodinamiki pri provedenii bikarbonatnogo i atsetatnogo gemodializa.

The article deals with the comparative analysis of certain values of homeostasis and hemodynamics in 25 patients with chronic renal failure who were subjected to systematic bicarbonate and acetate hemodialysis. Comparative study of some values of homeostasis, hemodynamics and myocardial contractility in patients with chronic renal failure during hemodialysis with acetate and bicarbonate solutions showed the advantages of bicarbonate hemodialysis. During bicarbonate hemodialysis, in addition to the patients' good tolerance to the procedure, the correction of the disturbed homeostasis was more physiological on the one hand, and positive shifts occurred in the activity of the blood circulatory system on the other. The study showed the expediency of using bicarbonate hemodialysis in patients with chronic renal failure with individual intolerance to acetate solution, and with severe heart failure and metabolic acidosis.

[The diagnosis and dispensary care of pregnant patients with nephropathy]. / Diagnostika i dispanserizatsiia bol'nykh s nefropatiei beremennykh.

365 females followed up for 4-6 years who had new-onset or repeated nephropathy at pregnancy (NP) showed during the II and III trimester impaired humoral immunity evident from elevated levels of IgA, IgM and CIC. NP relapses at repeated pregnancies occurred in 89%, residual manifestations of the disease in 45% of the examinees. Postnatal immunological studies of women with previous NP but no clinical signs of it at the time of examination still continued to demonstrate alterations in cellular and humoral immunity. Glomerular filtration rate in response to water loading indicated their reduced renal reserves. It is suggested that in nonpregnant females with an NP history this disease runs a subclinical course which may be considered a remission. This dictates certain diagnostic and therapeutic measures that should be taken to prevent complications. NP patients follow-up and regular check-ups help to decrease relevant risk at subsequent pregnancies.

[The use of the M-cholinomimetic test in predicting treatment efficacy in neurogenic bladder dysfunctions]. / Primenenie M-kholinomimeticheskogo testa v prognozirovanii éffektivnosti lecheniia neirogennykh disfunktsii mochevogo puzyria.

Presented are the first-hand correlations between therapeutic responses and hyper-response of the bladder of M-cholinomimetic drugs made by the authors on the basis of a follow-up of 98 children with hyper-reflex dysfunctions of the urinary bladder. The study revealed a definite relationship: the more pronounced hyper-response was, the more difficult it was to get a persistent effect of recovered function of the bladder. Out of 63 M-cholinomimetic-positive patients, the effective response was noted in 61.9 per cent, recovery, in 31.7 and improvement in 30.2. All of 35 cholinoceptive-negative patients (100 per cent) responded to the treatment: 77.1 per cent recovered, 22.9 per cent improved. Higher treatment response observed in cholinomimetic-negative patients could be explained by the fact that in the absence of hypersensitivity, i.e. in case of minimal "immaturity" of neuromuscular structures, it was much easier to recover the function of the bladder. And on the contrary, it was difficult to make the final prognosis for those with pronounced cholinoceptive hypersensitivity (positive tests) because of high possibility of therapeutically resistant patterns of disease. Thus, the efficacy on the treatment in children with hyper-reflex dysfunction of the urinary bladder was in inverse proportion to cholinoceptive hypersensitivity. Taking into account the currently absent methods of prognosis for therapeutic response of neurogenic dysfunctions of the urinary bladder the authors advised to use the M-cholinomimetic test for these purposes.

[Value of alpha adrenergic blocking agents in the complex treatment of hydronephrosis in children]. / Znachenie al' fa-adrenoblokatorov v kompleksnom lechenii gidronefroza u detei.

Results of a pharmacotest with phentolamine show that in hydronephrosis patients the amplitude of contractions of the ureter became 3 times greater, the tonometrical index was 2 times greater, the basic pressure became 2 times less. The including of adrenoblocking agents into the complex treatment of patients with functional obstruction of the ureteropelvic system facilitated considerable dilatation of the calyceal-pelvic system. Plastic operations were performed in 21 patients.

Plasmapheresis in overall treatment of renal immune diseases.

Polymorphism of the clinical picture manifested in pregnancy induced nephropathies necessitates the development of special immune methods of diagnosis, prevention and overall treatment. The changes in cellular and humoral immunity disclosed in this group of patients may serve as a starting point for elucidating the mechanism underlying pathogenesis of the disease and complications. Complex therapy, including medicinal preparations, dietotherapy and plasmapheresis contributes to normalizing the clinical course of pregnancy, correcting the immunologic status and decreasing the incidence of complications in the postpartum period.

[Immediate and late results of anti-reflux surgery in children]. / Blizhaishie i otdalennye rezul'taty antirefliuksnykh operatsii u detei.

Nearest and long-term results of 114 antireflux operations performed on 78 children were studied. Choice of the method of operative intervention, degree of ureterectasia on excretory urograms and functional state of the urinary bladder were shown to have an influence on results of antireflux operations. Best results were obtained following operations after Politano--Leadbetter and Kohen. Unsatisfactory results were mainly observed in III-IV degree ureterectasia and continuing dysfunction of the urinary bladder. Their amount was found to increase with longer terms of observations.