[Application of alpha1-adrenoblockers in treatment of ureteral calculi].

The results of evaluation of the efficacy of alpha1-adrenoblockers in treatment of ureteral calculi are presented. Comparative, prospective, placebo-uncontrolled nonrandomized single-center study was performed, which included 118 patients with solitary diagnosed calculi in various parts of ureter. After the pain relief, all the patients underwent conservative therapy aimed at spontaneous discharge of concretions. The maximum duration of conservative treatment was 28 days. Ultrasound monitoring was performed every week in all patients. The control group of patients received only Drotaverinum 40 mg three times a day, and analgesics. The main group received alpha1-adrenoblocker tamsulosin at a standard dose of 0.4 mg once a day along with Drotaverinum and analgesics. The overall probability of a discharge of concrements localized in the distal ureter was significantly (P = 0.02) higher in the patients treated with alpha1-adrenoblockers. Treatment regimen in main group of patients allowed better control of pain during all periods of observation, even if the discharge of concretions was not registered. The overall probability of migration of concrements from the proximal to the distal ureter in main group of patients was 52% versus 32% in controls (P = 0.17). The frequency of adverse effects was comparable in both groups. Vertigo, postural hypotension, and weakness were significantly more frequent in the main group of patients. Univariate and multivariate analyses of the proportional hazards model have demonstrated that the administration of alpha1-adrenoblocker increased the likelihood of a discharge of concrement from the distal ureter. It is shown that the nature of the applied therapy has directly influence on the risk of an earlier discharge of concretions. Inclusion of alpha1-adrenoblockers in the treatment scheme increased the probability of discharge of concrements at 4.11 times.

[Choice of urinary tract drainage in different age groups of patients with urolithiasis].

Retro- and prospective analyses of 802 case histories of patients with nephrostomic drainage (n=272), ureteral catheter (n=27) and ureteral stent (n=503) treated for urolithiasis in the urological department of M.F. Vladimirsky Moscow Region Research Clinical Institute and Zhukovsky city hospital hospitalized in 1995 to 2009 made it possible to develop algorithms of choice of upper urinary tract drainage depending on clinical and laboratory indices. Nephrostomic drainage is preferable in a single functioning kidney, acute obstructive pyelonephritis, anuria, hyperthermia above 38 degrees C, marked supravesical urodynamic disorder, in renal failure, serum creatinine over 200 mcmol/l, urea over 10 mmol/l, blood potassium over 5 mmol/l, uric acid over 380 mcmol/l and leukocytosis over 8 x 10(9) l. Draining with ureteral stent was used primarily in elective surgery--extracorporeal shock-wave lithotripsy and transurethral operations. Stenting was better tolerated and entailed less frequent complications. In the rest cases choice of drain method should be made by the urologist. In active inflammation, before getting antibioticogram, the drain should be followed by antibiotic treatment with fluoroquinolones, cephalosporines of the third or forth generation, aminoglycosides, carbapenems in standard doses.

[Transcutaneous nephrolithotripsy in presenile and senile patients].

A total of 323 transcutaneous roentgenoendoscopic operations were made in 212 patients from January 2000 to December 2009 including 96 operations in 81 presenile and senile patients (87 and 9 operations, respectively). Transcutaneous nephrolithotripsy (TCNT) eliminated concrement from the kidney for one session in 59 (72.8%) patients. It proved to be the most sparing treatment in serious clinical situations and provided maximally complete evacuation of the concrement from the kidney. A total complication rate was 14.8%. All the complications were cured with conservative pharmacotherapy. TCNT has the same indications as open surgery, is a method of choice in presenile and senile patients with large, stag-horn and recurrent concrements of the kidney, impacted pelvicoureteral concrements, in impaired renal urodynamics and high bacteriuria. TCNT can be used as a second-line treatment in failure of extracorporeal shock-wave lithotripsy or in combination with it (sandwich-therapy) for complete concrement elimination.

[Transurethral contact electroimpulse ureteropyelolithotripsy].

Transurethral contact electroimpulse ureteropyelolithotripsy (TCEUT) was conducted in 161 patients aged 18 to 84 years (mean age 47 +/- 14 years) admitted to the urological department of Zhukovsky city hospital in 2006-2009. Female/male proportion 1.4:1. Overall efficacy of TCEUT was 98%, the concrement was destructed completely during the first TCEUT session in 98%, partially in 2% cases. The method was feasible in all the patients if the instrument could reach the concrement. Duration of the session providing complete elimination of the concrements varied from 1 to 6 months.Contact electroimpulse ureterolithotripsy is conducted with single impulses beginning with low energy (0.45 J). Contact electroimpulse pyelolithotripsy requires a higher initial impulse energy (0.6 J). TCEUT is a highly effective method of the treatment of concrements of the upper urinary tract. Side effects were registered in maximum 5%. Long-term existence of the concrement in the urinary system raises the risk of intraoperative complications.

[Diagnosis and treatment of urolithiasis in combination with infravesical obstruction in presenile and senile patients].

The analysis of the results of examination and treatment of 510 urolithiasis patients with organic infravesical obstruction (IVO) treated in the urological clinic of M. F. Vladimirsky Moscow Regional Research Clinical Institute and in the urological department of Zhukovsky city hospital from 1995 to 2009 made it possible to arrive at the following conclusions: the above patients have obstruction symptoms in 100% cases, irritative symptoms--in more than 2/3 of the patients; combined use of low invasive, endoscopic and open methods reestablishes urodynamics of the lower urinary tract in more than 90% patients; the decision on the treatment policy and techniques depends on severity of clinical symptoms caused by IVO and urolithiasis as well as disturbance of upper and lower urinary tract urodynamics. In adequate choice of the patients and correct indications combined use of low invasive, endoscopic and open methods provides good treatment effect in patients with IVO and urolithiasis.

[Residual neurovirulence of the chimera of Langat and Denge-4 flaviviruses in intracerebral infection of monkeys].

The residual neurovirulence of the previously obtained chimeric virus Tp21/DEN4, containing the RNA region encoding the pre M and E structural enzymes, strain Tp21, virus Langat, and the remaining part of the genome from the Denge 4 virus, was studied in experiments with monkeys Cercopithecus aethiops involving the intracerebral administration of the virus. The tick-borne encephalitis virus, strain Absettarov, was used as positive control. A comparative analysis of the experimental and published data showed the chimeric virus to be less virulent by its degree of morphological affection in the CNS zones, its spread into the CNS and by a percentage share of animals with viremia versus the Tp21 parent strain and Elantsev strain of the Langat virus.

[Use of molecular biological method (MAPREC-test) for evaluating residual neurovirulence and genetic stability of oral poliovirus vaccine type 3]. / Ispol'zovanie molekuliarno-biologicheskogo metoda (MAPREC-testa) dlia otsenki ostatochnoi neirovirulentnosti i geneticheskoi stabil'nosti oral'noi poliovirusnoi vaktsiny tipa 3.

MAPREC test (mutant analysis by polymerase chain reaction and restriction enzyme cleavage), evaluating the content of neurovirulent mutants with nucleotide substitution of U for C in position 472 in the 5'-nontranslated RNA region, in a virus population was used for a retrospective analysis of 3 specimens of inoculated viruses and 55 lots of type 3 oral poliovirus vaccine (OPV) prepared at M. P. Chumakov Institute of Poliomyelitis, Russian Academy of Medical Sciences, during recent 6 years. The mean content of neurovirulent mutants in inoculated viruses was 0.26 +/- 0.06%, in monovaccines 0.34 +/- 0.04% (the maximum allowable content is 1%). The method is well reproducible and detects about 0.1% mutants in the population. MAPREC test can be used instead of currently used residual virulence control on monkeys, as it detects viral preparations which were not tested on monkeys and does not reject high-quality vaccines. The protocol of using this method in combination with other methods for neurovirulence and genetic stability control of type 3 OPV is discussed.