[Evaluation of upper urinary tract function in patients undergoing autoplastic surgery for hydronphrosis of the intrarenal pelvis].

AIM: To investigate the functional state of the upper urinary tract in patients undergoing autoplastic surgery for a hydronophrosis of the intrarenal pelvis. MATERIAL AND METHODS: The study comprised 78 patients with the intrarenal pelvis and impaired urinary outflow due to stricture of the ureteropelvic junction and vascular conflict (interatrial and arteriovenous narrowing), who underwent pyeloplasty using autologous tunica vaginalis. All patients underwent an incision of ureteropelvic stricture and resection of the parietal layer of the tunica vaginalis which was used to repair the obstruction site and internal stenting of the upper urinary tract. RESULTS: The patients were examined at baseline and during follow-up ranging from 3 months to 3 years. At three months after surgery, there was a decrease in the size of the renal pelvis and calyces with an improvement of all parameters of uro- and hemodynamics. At three years after surgery, the structural and functional parameters of the upper urinary tract were completely restored. CONCLUSION: Obstructive uropathy, resulting from the intrarenal pelvis, leads to persistently impaired urinary outflow from the upper urinary tract. Surgical intervention is the only curative treatment able to restore the urinary flow. In men with the intrarenal pelvis, the autoplastic surgery of the ureteropelvic junction obstruction using a parietal layer of the tunica vaginalis is an effective surgical modality improving renal pelvis capacity and contributing to the recovery of urinary outflow from the upper urinary tract.

[Experimental work: reconstruction of the pelvi-ureteric junction and ureter using testicular tunica vaginalis autograft].

AIM: To evaluate the results of surgical reconstruction of the upper urinary tract using an autograft of testicular tunica vaginalis in experimental animals. MATERIALS AND METHODS: The article presents the results of partial replacement of the renal pelvis and ureter with an autograft in 25 male dogs. The grafts were harvested by resection of the parietal layer of the testicular tunica vaginalis, which was transplanted into the region of the pelvi-ureteric junction and the proximal ureter. The upper urinary tract was drained using a ureteral stent catheter. The results were evaluated at week 1 and months 1, 3 and six after the operation. The functional state of the kidneys and ureters was analyzed using excretory urography and ultrasound; the autograft biopsy specimens were examined histologically. RESULTS: In all cases, the viability of the autograft was completely preserved, there were no signs of secondary infection, necrosis and impaired patency in the anastomosis zone. Histological examination revealed signs of epithelialization, connective tissue substitution and neovasculogenesis in the implantation zone. CONCLUSION: The proposed surgical modality is an alternative method to restore normal urine flow in the upper urinary tract in obstructive urological diseases. The group of obstructive urological diseases was studied using the model of the strictures of the pelvi-ureteric junction in the intrarenal pelvis and ureteral strictures measuring up to 3-4 cm in length.

Disorders of the immune system in severely burned patients.

This paper analyses the results of immunological examinations of 124 patients with thermal injury. We examined indices of peripheral blood such us the size of the population of circulating T-lymphocytes (CD3), T-helpers (CD4), T-suppressors (CD8 and CD25), natural cell killers (CD16), transmembrane protein of apoptotic activity (CD16), B-lymphocytes, phagocyte activity of lymphocytes, and the level of serum antibody of the basic classes (Ig G, A, M). It was discovered that the burn disease was accompanied by deeply marked secondary immune deficiency primarily caused by all components of the active suppression of the cellular link of the immune system and reduction of phagocyte activity of neutrophils.

[Blood serum of patients with secondary progressive multiple sclerosis changes neuron electric activity].

An effect of 20% blood serum estimated by the changes of background and excited spike activity of Retzius' neuron by Hirudo medicinalis, which does not contain myelin, has been studied in 2 groups of patients. The first group comprised patients with serum, containing antibodies to gangliosides, and the second one--patients without such antibodies. Incubation of Reitzius neurons in the serum with GM1-antibodies within 40 min resulted in the change of spike form, increase of cell stimulation threshold by average 20%, reduction of the frequency of spontaneous impulse activity by average 28%, decrease of the spikes number in response to the lower frequency (0.5 Hz) synaptic stimulation and inhibition of adaptation to the high frequency (10 Hz) stimulation. The use of the serum without GM1-antibodies caused a different change of the spike form and increased the stimulation threshold by 8% and sparser background impulse activity of the neuron by 40%. During low frequency synaptic activation of the neuron (0.5%), there was sensitivity disturbance and inhibition of the electric response to the high frequency stimulation. The results suggest that neuron injuries in multiple sclerosis may develop before morphological appearances of myelin lesions.

[Axonal reaction precedes demyelination in experimental models of multiple sclerosis]. / Reaktsiia aksonov predshestvuet demielinizatsii v éksperimental'nykh modeliakh rasseiannogo skleroza.

Taking into consideration that myelin phospholipids may be partially synthesized in neuronal bodies, while neurilemma readily reacts with antibodies against gangliosides by changing the properties of membrane ionic channels, the attempt was made to test the proposed assumption of the early axonal reaction in demyelinating processes in experimental models of multiple sclerosis. The models of chronic allergic encephalomyelitis in Lewis rats injected with homogenate of highly purified myelin or total brain gangliosides were used. First signs of demyelination (the destruction of intermediate dense lines) were demonstrated in the inner layers of myelin close to axon and were shown to develop synchronously with the aggregation of filamentous-tubular material in the neuroplasm. These changes are associated with significant shift of the ratio of myelin sheath thickness to axonal diameter (from 1:7-1:3 to 2:1-3:1). This swelling of myelin seems to be caused by neuroplasmic proteins aggregation, that must be accompanied by the drop in oncotic pressure and the separation of loosely-bound water fraction that may be assimilated by myelin. At light microscopic level the increase of myelin thickness is clearly observed that is in exact correspondence with the decrease in axonal diameter. The process starts with the exfoliation and swelling of the nodes of Ranvier and the incisures of myelin, which fuse after elongation, that corresponds to the total disintegration of myelin with the preservation of continuity of axon which appears to be harshly shrunken.

Serum ganglioside patterns in multiple sclerosis.

The relative distribution of gangliosides was determined in the serum of 37 patients with multiple sclerosis (MS) and of 30 healthy subjects. There was a significant increase of GM1 and GD1a, and a decrease of GM3 proportion in the serum of relapsing-remitting MS patients (RRMS) during their first MS attack. The RRMS patients in relapse with a long duration of the disease had a significant decrease of GM1 and an increase of GD1a portion in the serum. An increase of GD1a, one of the major brain neuron ganglioside fraction, suggested the neuron injury in the early and with a long duration RRMS. The finding of an increase of GM1, the main human myelin ganglioside, during the first MS attack in RRMS patients confirms previous evidence for the possible involvement of gangliosides in the early pathological course of demyelination in MS.