[Treatment of erectile dysfunction in cases of venous and corporovenous insufficiency of phallus]. / Lechenie érektil'noi disfunktsii pri venoznoi i korporovenoznoi nedostatochnosti polovogo chlena.

A total of 230 patients of different age with impaired venous drainage of penis cavernous bodies were examined. Test with intracavernous injection of papaverin, dopplerography of the vessels and cavernosometry were employed. To treat venous and corporovenous insufficiency, it is suggested to make a resection of the deep dorsal vein, ligation of the superficial and circular veins with suturing tunica albuginea. In negative result of the surgery viagra in a done 50 (100) mg is recommended or penile implants.

[Left-side varicocele and infertility: diagnosis and treatment]. / Levostoronnee varikotsele i besplodie: diagnostika i lechenie.

Eighty-four patients with left varicocele were subjected to complex examination to identify the causes of disturbed spermatogenesis. It was found that not only the testis but the adrenal also is involved in the pathological process in varicocele caused by venous renal hypertension. Changes of venous hemodynamics in the left adrenal lead to activation of steroidogenesis in its cortex and, consequently, to impairment of spermatogenesis in both testes. As the result of the study a new method for the treatment of sterility in patients with left varicocele was suggested, namely, X-ray-guided endovascular occlusion of the central vein of the left adrenal. Tentative evaluation of the results of the intervention gives hope of its efficacy.

[The activities of the renin-angiotensin-aldosterone and sympathetic-adrenal systems during hemodialysis]. / Aktivnost' renin-angiotenzin-al'dosteronovoi i simpato-adrenalovoi sistem vo vremia gemodializa.

The authors analysed the dynamics of the activity of the renin-angiotensin-aldosterone, hypophyseal-adrenal, and sympathoadrenal systems in 46 patients during a hemodialysis session according to the type of hemodynamics. No essential changes were encountered in the hormone concentration in patients with normotension and "controllable" hypertension. In patients with "uncontrollable" hypertension the dialysis dehydration was attended by increased activity of the renin-angiotensin-aldosterone system, the level of cortisol and the adrenocorticotropic hormone increased slightly. Daily catecholamine excretion was 2-3.5 times below the lowest normal value. Noradrenaline clearance of the plasma membrane dialyser was 82.1 ml/min. Increase in the concentration of noradrenaline, and the activity of renin and aldosterone were encountered both in hypotension and in arterial hypertension. It is concluded that disturbed water balance, dyselectrolythemia, anemia, infectious complications, etc. are the trigger factor of decompensation of the system of the hormonal hemodynamic regulation. Substitution adrenomimetic therapy for arresting collaptoid reactions is inexpedient. Systematic use of medicinal agents should be avoided in favour of a search for an optimal dialysis regimen, should this prove ineffective the decision should be made in favour of an operation.

[The x-ray endovascular treatment of renin-dependent arterial hypertension with secondary aldosteronism in patients without vasorenal involvement]. / Rentgenoéndovaskuliarnoe lechenie reninzavisimoi arterial'noi gipertenzii s vtorichnym al'dosteronizmom u bol'nykh bez vazorenal'nogo porazheniia.

In 20% of cases, essential hypertension is of high renin pathogenesis which is indifferent of that of renal lesions. In these patients high blood pressure is closely related to high aldosterone generation due to elevated angiotensin II levels. Adrenal blood portalization is a possible way of abolishing secondary aldosteronism and hyperreninemia in this case. With this, 90-98% aldosterone and 20-30% renin are inactivated, which served as the basis for bilateral electrocoagulation of adrenal central veins in 13 patients with permanent and malignant arterial hypertension. The renin-dependent pattern of essential hypertension was confirmed by a positive BP response to a tested captopril dose (25 mg), the vasorenal one was ruled out on the basis of the peripheral captopril test, captopril pharmacorenography. Bilateral electrocoagulation of adrenal central veins was performed during a phlebographic examination. The manipulation proved to be successful on 11 (85%) left and 9 (70%) right adrenals. Blood pressure became lower in the first day and stable on days 4-5. There was a significant decrease in blood pressure at a year follow-up, in increased aldosterone levels, plasma renin activity with unchanged adrenocorticotropic hormone concentrations. After the manipulation, 2 patients refused to take antihypertensive drugs, 11 patients received lower doses of drugs. The method for abolishing secondary aldosteronism is considered to be promising for further clinical studies. A special attention should be given to patients with diseases concomitant with essential hypertension who have no alternative to surgical treatment.

[The diagnosis and treatment of arterial hypertension in patients on hemodialysis treatment and after a kidney allograft]. / Diagnostika i lechenie arterial'noi gipertenzii u bol'nykh na lechenii gemodializom i posle allotransplantatsii pochki.

Analysis of examination and treatment of 104 patients who were periodically exposed to hemodialysis and 60 persons who sustained the allotransplantation of a cadaveric kidney enabled the authors to reveal the incidence of arterial hypertension before and after the transplantation. Pronounced arterial hypertension (AH) was documented in patients who were treated with hemodialysis sessions for the proper renal diseases developed in angionephrosclerosis (chronic glomerulo- and pyelonephritis). In those who sustained the transplantation, AH was pronounced in case of acute of chronic rejection, transplanted artery stenosis of renal renin hyperproduction. Higher incidence of AH (2.3-fold higher) was observed in posttransplantation patients with the native kidney left. It correlated with higher peripheral plasma renin activity (RRA). The authors suggested that the scheme should be used for the diagnosis of AH manifestation both before and after the transplantation which included the account for the cause of the disease terminal stage, the character of the AH variance in hemodialysis captopril testing, radiocardiographic examination, indirect renal angiography (99-Tc pertechnetate) or selective blood testing for RPA in case bilateral nephrectomy should be made in two stages. For the patients who had sustained the transplantation of the kidney, the diagnostic scheme should include a double pulse Doppler sonography, arteriographic investigation of the transplant and pharmacorenography with a captopril load test. Advisability of captopril stimulation of renin secretion during the selective sampling of the blood was demonstrated. The authors verified the time-course of renin activity, the concentration of aldosterone, cortisol and adrenocorticotrophic hormone in patients with a history of bilateral nephrectomy, defined the indications for bilateral nephrectomy associated with AH and discussed its possible outcomes.(ABSTRACT TRUNCATED AT 250 WORDS)

[The role of the functional interrelation of the adrenals and testes in the pathogenesis of sterility in patients with left-sided varicocele]. / Rol' funktsional'noi vzaimosviazi nadpochechnikov i iaichek v patogeneze besplodiia u bol'nykh s levostoronnym varikotsele.

Selective renal phlebography, phlebotonometry, selective analysis of the blood from the renal veins and vena cava inferior for the activity of plasma renin, catecholamines, prostaglandins E2, pO2 and pCO2, peripheral blood analysis for levels of progesterone, androstendione, testosterone, ACTH, ACTH-tolerance test, orchidometry, ejaculate microscopy, evaluation of seminal plasma testosterone, trochanter index and parameters of sexual maturation were performed during the treatment of 70 patients with left varicocele. Based on the results the authors concluded that not only the left testicle, but the left adrenal was involved in the course of organic renal venous hypertension. A significant feedback correlation was revealed between the peripheral blood progesterone and the left kidney venous pressure (r = -0.50, p less than 0.01) and between the peripheral blood progesterone and the number of motile spermatozoa in the ejaculate (r = -0.31, p less than 0.05). Pathogenesis of organic renal venous hypertension and spermatogenesis failure were supplemented by the conclusion that the left adrenal central vein was the first to involve into the compensation of venous hypertension. Retrograde alterations in the direction of the blood flow in the left adrenal central vein resulted in the abnormal stimulation of steroidogenesis in the cortical layer. The excessive production of antiandrogenic steroid hormones by the left adrenal gland was a cause of spermatogenesis damage in both testicles. The blockage of the left adrenal androgenic hormones of the hypothalamo-hypophyseal system can deteriorate the process.(ABSTRACT TRUNCATED AT 250 WORDS)

[The effect of renal arterio- and phlebography on the function of the renin-angiotensin and hypophyseal-adrenal systems]. / Vliianie pochechnoi arterioflebografii na funktsional'noe sostoianie renin-angiotenzinnoi i gipofizarno-nadpochechnikovoi sistem.

Based on the analysis of a RX-ray study and a selective blood test for the activity of the plasma renin, aldesterone, hydrocortisone and adrenocorticotropic hormone (ACTH) in 57 patients with arterial hypertension--14 persons without renal failure, 14 ones regularly treated by hemodialysis, 29 patients with left orthostatic varicocele--the authors demonstrated the impact of the renal arterio- and phlebography on the hormone levels studied. Arteriography resulted in an increase in the absolute value of the renal vein renin mean 2.1-fold, aldosterone, 3.3-fold and hydrocortisone, 1.7-fold. A 2.2-fold increase in the renin activity and a 2.6-fold increase in the levels of aldosterone and hydrocortisone noted in all the patients were the result of retrograde renal phlebography. No correlations were established between the changes in hormone levels and the central mechanism of the secretion regulation (ACTH). Radiopaque investigations of the patients with arterial hypertension gave 22 per cent of false positive results with regard to the site of renin secretion and 18 per cent of those with regard to the participation of the studied kidney in renin secretion. The authors supposed a possible regulation of adrenal mineralocorticoid performance by a retrograde blood flow appeared through the adrenal central veins that was induced by phlebography--related elevation of blood pressure in the renal vein.

[Diagnosis and roentgeno-endovascular treatment of patients with renin-dependent arterial hypertension and secondary aldosteronism without damage to the main renal arteries]. / Diagnostika i rentgenoéndovaskuliarnoe lechenie bol'nykh reninzavisimoi arterial'noi gipertenziei so vtorichnym al'dosteronizmom bez porazheniia magistral'nykh arterii pochek.

Bilateral electrocoagulation of the central veins of the adrenals (ECVA) was performed in 13 patients with stable and malignant arterial hypertension (AH). The renin-dependent character of AH was supported by positive reaction of arterial pressure (AP) to the test dose of captopril (25 mg). The vasorenal origin of the impairment was excluded on the basis of the peripheral captopril test findings, pharmacorenography with captopril. Bilateral ECVA was done during angiography. The manipulation turned out technically successful in 11 left (85%) and 9 right (70%) adrenals. The AP began lowering from the first days of the intervention and got stabilized by day 4 to 5. There was a significant decline of AP within the observation period up to 1 year and a reduction of the elevated aldosterone content and plasma renin activity with the content of ACTH being unchanged. After the manipulation 2 patients could fully discontinue the intake of hypotensive drugs. In 11 patients, the dose of the drugs could be reduced.

[The role of disorders of mineralocorticoid function of the adrenal glands in the development of infertility in patients with left-side varicocele]. / Rol' narushenii mineralogliukokortikoidnoi funktsii nadpochechnikov v razvitii besplodiia u bol'nykh s levostoronnim varikotsele.

A combined study, including phlebography, phlebotonometry, orchidometry, morphometric determination of microcirculatory testicular volume, microscopic and biochemical ejaculate studies, determination of peripheral blood levels of adrenocortical mineral glucocorticoid hormones before and after ACTH administration in the blood, sampled from various veins prior to phlebography, assessment of osmolality, pO2 and pCO2 in the blood samples from spermatic venous plexus, left renal vein and intrarenal portion of the vena cava inferior, and determination of plasma renin activity in renal veins, was conducted in 55 patients with varicocele. A considerable increase in orthostatic blood pressure of the left spermatic venous plexus is demonstrated that may be due to retrograde blood flow in the left testicular venous plexus, resulting in a microcirculatory disturbance and gradual atrophy of a testicle. There was a correlation between the severity of varicocele and left-testicular volume which was absent for total testicular volume, while microcirculatory volumes of the testes differed significantly, suggesting the absence of hemodynamic disorders in the contralateral testicle and, consequently, no spermatogenetic impairment due to hemodynamic changes in cases of a unilateral varicocele. Phlebographic and phlebotonometric evidence points to a retrograde blood flow through the central vein of the left adrenal. The results of adrenal functional studies demonstrate a significant tendency to adrenal hypersynthesis of aldosterone and cortisol in patients with varicocele. A correlation demonstrated between peripheral blood cortisol level and the proportion of spermatozoa with abnormal headpiece structure in the ejaculate has suggested a cause-and-effect relationship between adrenal dysfunction and infertility in patients with varicocele.