[Diagnostic nomograms for the treatment of urogenital fistula].

AIM: Studies on non-obstetric urogenital fistula provide limited information on predictive factors. The aim of our study was to specify and to analyze the predictors for long-term anatomical and functional results in women with non-obstetric urogenital fistula. MATERIALS AND METHODS: A cross-section study of surgical repair for non-obstetric urogenital fistula repairs was carried out. From 2012 to 2018, a total of 446 patients with urogenital fistulas were treated in two tertiary centers. Patients with vesicovaginal and urethrovaginal fistulas with at least 12 months of follow-up were identified and contacted by phone and/or examined in the clinic. Anatomical outcome was assessed by resolution of symptoms and/or results of clinical examination. Urinary distress inventory (UDI-6) was used for the measurement of functional outcomes. The nomogram is based on a multiple regression equation, the solution of which is performed using a computer. The nomogram is presented as a set of scales, each of which corresponds to a certain variable. The baseline parameter is assigned certain points, depending on its value, then the sum of all parameters is calculated. As a result, it is possible to determine the risk using a couple or three scales. RESULTS: Overall, 169 patients were studied (mean age of 49.2, mean follow-up of 34 months). The most common cause of fistulas included hysterectomy (69.4%), followed by pelvic radiotherapy (18.9%). Only 64% of cases were primary fistula. Closure rate was 90.7% (98/108). Anatomical success depended on the surgical approach. For transvesical procedure, success rate was 89.4% (42/47), compared to 84% (89/106) and 87.5% (14/16), respectively for transvaginal and transabdominal success rate. According to Clavien-Dindo, complications were grade 1 (11.8%) and grade 2 (4.7%). As UDI-6 showed, the most common symptoms were frequency (62%), urgency (50%), incontinence (73%), pain (55%) and voiding symptoms (27%). Fistula size > 3.0 cm, pelvic radiation, and previous vaginal surgeries were associated with a higher risk of failure or more severe lower urinary tract symptoms. A high number of re-do cases and complex fistulas could be a limitation of this study. Factors for successful non-obstetric urogenital fistula closure were fistula size less than 3.0 cm, absence of pelvic radiation, and previous vaginal surgeries. CONCLUSION: According to our results, only fistula size > 3 cm, previous vaginal procedures and pelvis irradiation were unfavorable predictors for anatomic success of fistula repair. In addition, our results allow to determine the predictors for successful repair and risk of recurrence lower urinary tract symptoms postoperatively.

[Systematic review of current russian-language literature on urogenital fistulas in women].

Urogenital fistulas in women are an urgent problem in modern urology, gynecology and surgery. Several decades earlier, iatrogenic damage was the main reason for their development. The aim of this review was to analyze the etiology, characteristics and results of treatment of fistulas in women in Russia and the CIS countries. A systematic analysis of the articles in the PubMed and eLibrary databases dedicated to etiology, treatment technique and postoperative results of treatment of urogenital fistulas in women was carried out. The results were compared with European data. A total of 16 articles were selected over a 20-year period that met the inclusion criteria. Iatrogenic injury resulted in the fistula formation in 40.54% (373/920) of cases. The majority of fistulas were caused by radiation therapy (58.91%, 542/920). According to the results, 84.02% (773/920) of fistulas were successfully healed. Cure rate of patients with post-radiation fistulas was 75.83% (411/542). Comparison of surgical techniques was difficult, since in most cases the preference of the surgeon was main determinant factor.

Effects of allogenic fetal pancreatic tissue transplantation on regeneration of islet cells in recipient rats with alloxan-induced diabetes mellitus.

The linear parameters and number of Langerhans islets were evaluated in rats with alloxaninduced diabetes mellitus after transplantation of fetal pancreatic tissue to the anterior chamber of the eye. The islets significantly increased in size by week 3 after surgery and a trend to an increase in their number was observed.

[Effects of amyloid-ß peptide Aß(25-35) on glycolytic and antioxidant enzymes of different ages].

Amyloid-ß peptide Aß(25-35) was shown to cause lysis of rat erythrocytes of different ages. The toxicity of Aß(25-35) positively correlated with both the erythrocyte age andthe peptide concentration. The activity of glycolytic, antioxidant, and Na+/K(+)-ATPase enzymes decreased with erythrocyte aging in vivo. In vitro Aß(25-35) reduced the activity of hexokinase, phosphofructokinase, pyruvate kinase, glutathione peroxidase, and glutathione transferase and increased Na+/K(+)-ATPase activity in aged erythrocytes to a greater degree than in young cells.

[Syphilitic cerebral vasculitis: diagnostic possibilities].

We studied 1387 patients with different forms of syphilis for neurological deficiency. Thirty patients had vascular neurosyphilis. Two cases are described in detail. A 40-year-old man had recurring episodes of acute disturbance of the cerebral blood flow and progressive cognitive disorders. A 32-year-old patient presented with progressive dementia, hallucinatory symptoms and minor multifocal neurological changes. The diagnosis of neurosyphilis was verified by CSF-test results. The diagnosis of cerebral vasculitis was proved by the data of magnetic resonance imaging (MRI), magnetic resonance (MR) angiography, ophthalmological methods, and duplex scanning of brachiocephalic arteries, transcranial duplex scanning. Diagnostic criteria of syphilitic cerebral vasculitis were defined and presented.

[Preclinical diagnostics and correction of the disturbed renal blood flow in the children presenting with diabetic nephropathy].

The present study included 86 children aged between 7 and 17 years with type 1 diabetes mellitus from 1 to 15 years in duration. In all the patients, renal blood flow was investigated with the use of ultrasonic dopplerography. The results of the study suggest disturbances of intrarenal hemodynamics that manifested themselves as enhanced resistance of renal arteries from periphery to the centre in the patients at the hyperfiltration stage of diabetic nephropathy (DN) in conjunction with the reduced velocity of blood flow in inter-lobular and segmental arteries. In contrast, the patients at the microalbuminuric stage of diabetic nephropathy exhibited increased resistance and reduced velocity of blood flow in the main renal veins. In 35 patients presenting with diabetic nephropathy, hemodynamic correction was achieved by the application of the traveling pulsed magnetic field (TP-MF) to the renal region using an AMO-ATOS-E apparatus (Russia). This treatment resulted in normalization of the characteristics of renal blood flow. It is concluded that TPMF has good prospects for the use as a component of the combined treatment of diabetic nephropathy.

[Arginase, nitrates, and nitrites in the blood plasma and erythrocytes in hypertension and after therapy with lisinopril and simvastatin].

Arginase activity in erythrocytes is higher in patients with arterial hypertension and atherosclerosis as compared with healthy people. Therapy with either lisinopril alone or in combination with simvastatin for 3-6 months causes a decrease in the arginase activity to the control level. Both the monotherapy and the combination therapy increased the concentrations of NO2(-), NO3(-), and total NOO2(-) + NO3(-)in the plasma of hypertensive patients. The NO2(-) + NO3(-) concentration in erythrocytes decreases in hypertensive patients but is completely restored after therapy with lisinopril alone or in combination with simvastatin. Thus, lisinopril and lisinopril plus simvastatin display a pronounced and equal normalizing effect on arginase activity in human erythrocytes, which is elevated in hypertension, as well as on the endothelial nitric oxide synthase activity, which is decreased in hypertension.

[Hairy cell leukemia in young patients].

AIM: To characterize clinical symptoms, course, immediate and long-term treatment results in young patients with hair cell leukemia (HCL). MATERIAL AND METHODS: The data on 41 HCL patients were analysed. The diagnosis was made by standard diagnostic protocol for HCL detection. RESULTS: The analysis of the age of 160 HCL patients studied demonstrated high (26%) incidence of HCL at young age. Young patients with HCL had special clinical manifestations and specific long-term outcomes of treatment with standard schemes. CONCLUSION: Differences in occurrence of recurrences after standard therapy make it necessary to consider young HCL patients as a separate group who need adjuvant treatment to prolong remission.

Barriers to prenatal care and poor pregnancy outcomes among women with syphilis in the Russian Federation.

We studied predictors of no prenatal care (PNC) and influence of no PNC on pregnancy outcome in a multisite study of 1071 women with syphilis in Russia. We assessed PNC utilization, HIV testing, syphilis treatment, and pregnancy outcome. We found that 37% of women with syphilis received no PNC, and 1% was HIV infected. Lacking official residency status was independently related to no PNC (adjusted odds ratio [AOR]: 8.1; 95% confidence intervals [CI]: 5.3-12.3). Among women with inadequately treated current syphilis, those without PNC were more likely to have a stillborn infant than those with PNC (25% vs. 3%, odds ratio [OR] 9.5, 95% CI 4.0-23.5). Women with adequately treated current syphilis and no PNC were more likely to deliver a low birth weight (OR 3.8; 95% CI 1.8-8.1) or preterm infant (OR 3.9; 95%CI 1.8-8.7). Women with previous or current syphilis and no PNC were significantly more likely to abandon their infants.

[Clonal chromosomal aberrations in patients with aplastic anemia at the disease onset and transformation].

AIM: To estimate detectability and characteristic features of chromosomal aberrations in bone marrow cells of patients with aplastic anemia (AA). MATERIAL AND METHODS: The trial covered 155 AA patients admitted to the Hematological Research Center in 1987-2002. Cytogenetic study by G-differential staining was performed in 58 patients with AA and 5 patients with AA transforming into myelodysplastic syndrome (MDS) or acute leukemia (AL). Cytogenetic and morphological specimens of the latter's bone marrow were studied retrospectively using fluorescent in situ hybridization (FISH) with DNA probes for detection of monosomia 7 and deletion 7q. RESULTS: Clonal chromosomal aberrations were detected in 4 out of 28 patients. Further examinations revealed no aberrations. Clonal diseases developed in 7 (4.5%) of 155 patients. In 2 patients the disease transformed into paroxysmal nocturnal hemoglobinuria, 5 (3.2%) patients developed variants of MDS and AL. Monosomia 7 or deletion 7q were diagnosed in 3 cases of MDS/AL. In retrospective study of bone marrow specimens of patients with transformation in MDS/AL with monosomia 7, FISH recognized a small elevation over control values in 2 cases. CONCLUSION: Stable clonal chromosomal aberrations are not characteristic of AA. Some AA patients with subsequent MDS/AL may have minor neoplastic clone in the disease onset.

[Chromosomal aberrations in myelodysplastic syndrome].

AIM: To analyse incidence rate of chromosomal aberrations in myelodysplastic syndromes (MDS), specification of clinicomorphological features of some cytogenetic variants. MATERIAL AND METHODS: Chromosomal analysis by the method of G-differential staining of chromosomes was made in 209 patients with different variants of MDS. RESULTS; Clonal chromosomal aberrations occured in 60.8%. The following aberrations were found most frequently: deletion of the long arm of the chromosome 5 (del(5q)) - 34.6%, trisomy of chromosome 8 (14.1%), monosomy of chromosome 7 (13.4%), aberrations 3q21q26 (12.6%), aberrations of a long arm of X-chromosome (4.7%), the absence of Y-chromosome (3.1%). Complex aberrations of karyotype were found in 13.5% cases. Chromosomal aberrations determined not only clinical and morphological features but also the prognosis of the disease. CONCLUSION: Cytogenetic examination is an essential component of MDS patients examination. It allows more precise classification of MDS variant and prognostification of the disease course.

[Acute lymphoblastic leukemias with aberrations of BCR-ABL genes].

AIM: To develop an original therapeutic strategy in Ph-positive acute lymphoblastic leukemia (ALL). MATERIAL AND METHODS: In November 2001 Hematological Research Center (HRC) initiated the study of chimeric BCR-ABL gene. During the first stage of the study (November 2001-July 2004), 18 primary ALL patients were recruited in HRC, from July 2004 to January 2005--16 patients in HRC, N.N. Burdenko Central Military Hospital, regional Samara hospital. The diagnosis of Ph-positive ALL was established in detection of translocation t(9;22) by standard cytogenetic test or fluorescent hibridization in situ with double signal (D-FISH), or by polymerase chain reaction with reverse transcription (RT-PCR). In detection of aberration of BCR-ABL gene the patients received stem hemopoietic cells, from June 2004 imatinib was added to chemotherapy in the period of induction and consolidation. RESULTS: Incidence rate of BCR-ABL-positive ALL by standard cytogenetic test and D-FISH makes up 20%, by RT-PCR--25%. Differences in chimeric transcripts detectability by different methods may be explained by different sensitivity of the methods. Complete hematological remissions were achieved in the majority of the patients (6 of 8) irrespective of imatinib administration. Achievement of molecular remission in BCR-ABL-positive ALL occurs also in standard chemotherapy but molecular remissions begin 2-4 months later than clinicohematological ones. CONCLUSION: In using imatinib combination with chemotherapy, molecular remission can be achieved simultaneously with hematological one. Long-term results will be analysed later.

[Intramural nervous apparatus of jejunum and rectum in experimental portal hypertension]. / Intramural'nyi nervnyi apparat toshchei i priamoi kishok pri éksperimental'noi portal'noi gipertenzii.

Using histological and electron microscopical methods, the state of intramural nervous structures of jejunum and rectum was studied in 92 dogs with experimental portal hypertension. Three phases of changes of portal pressure were detected and its influence upon the intramural nervous apparatus was observed. In phase 1 (first 4-5 days after the surgery) the reactive changes of the nervous apparatus were shown that were more pronounced in jejunum. In phase 2 (day 5 to 2.5 months) the portal pressure was shown to drop; this was accompanied by some signs of regeneration in jejunum and by an aggravation of destructive processes in rectum. In phase 3 of the repeated rise of portal pressure (2.5 to 6.5 months after the surgery), destructive changes in the nervous apparatus were demonstrated that were similar to those found in phase 1. However, the differences in the reaction of nervous structures in different layers of intestinal tube and the heterogeneity of the changes of the nervous apparatus in jejunum and rectum were absent. The association of time of appearance and of severity of structural changes with the elevation of portal pressure suggests the significant role of vascular factor in the morphogenesis of alterations observed in phase 3 of hemodynamic changes.

[T-cell tumors with aplastic syndromes]. / T-kletochnye opukholi, protekaiushchie s aplasticheskimi sindromami.

AIM: To detect and verify the existence of a specific form of T-cell tumor accompanied by isolated lesions of bone marrow and aplastic syndromes. MATERIAL AND METHODS: Four patients with aplastic syndromes were examined using clinical, histological, cytological, cytogenetic, and immunophenotypic methods. RESULTS: Four cases of T-cell tumors of bone marrow with clinical and morphological manifestations of aplastic syndrome and scanty proliferation activity in bone marrow alone were diagnosed. The proliferation activity in bone marrow was observed as formation of small clusters composed of small-size lymphoid cells with dense nucleus. Dynamic monitoring of two patients revealed a trend toward an increase in the lymphoproliferation base against the remaining clinical picture of aplastic syndrome. The T-cell immunophenotype characterized by disappearance of some markers or decrease in their density, was observed only in some blood and bone marrow lymphocytes. The most significant changes of immunophenotype were observed in one of the patients (CD2+CD3-CD4-CD5-CD7-CD8-CD16-CD56-CD45RO++). The same patient had pronounced cytogenetic changes (47XY+Y[8], 47, XY, del(1)(p10) [23], 46 XY [3]) and resistance to routine therapy, including cyclosporin. In one patient the process transformed into lymphosarcoma. CONCLUSION: The results obtained in four patients allow their clinicomorphological characteristics to be regarded as particular forms of T-cell tumors accompanied by bone marrow damage and aplastic syndrome.

[Morphological, morphometrical, and immunophenotypic characteristics of primary mediastinal B-cell lymphosarcoma]. / Morfologicheskie, morfometricheskie i immunofenotipicheskie kharakteristiki pervichnoi mediastinal'noi B-kletochnoi limfosarkomy.

AIM: To define histological, cytological, computer-morphometric and immunophenotypical features of primary mediastinal B-cell lymphosarcoma. MATERIAL AND METHOD: The study enrolled 43 patients with primary mediastinal B-cell lymphosarcoma (PMBCL) treated in Hematological Research Center from 1994 to 2002. The examination included morphological and immunophenotypical tests, computer morphometry of the cells by histological sections. RESULTS: PMBCL is represented by a composite population of cells of a giant, large and small size (nuclear areas 76.24 +/- 19.99, 37.77 +/- 8.0 and 17.12 +/- 4.34 mcm2. Three types were identified: giant-cell, large-cell and small-cell. A giant-cell type is represented by large and giant cells comprising, on the average, 44 and 31% of overall number of lymphoid cells. A large-cell type is primarily represented by large lymphoid cells (62% of the lymphoid population). Small-size type is represented by small cells (72% of cells). Frequent histological signs are diffuse sclerosis and focal necrosis. Tumor cells have B-cell nature. In the giant and large cell type more than 70% cells express PCNA, in the small cell type--less than 30%. Expression of activation marker CD30 is observed in 18% cases in the giant and large cell types. CONCLUSION: PMBCL is a morphologically heterogenous disease represented by combination of giant, large and small cells with immunophenotypically B-cell nature characterized in a giant cell and large cell type by prominent but in a small cell and large cell type by insignificant proliferative activity. CD30 expression is observed only in giant cell and large cell types.

Congenital syphilis in the Russian Federation: magnitude, determinants, and consequences.

OBJECTIVES: Reported cases of congenital syphilis in the Russian Federation increased 26-fold from 1991-9. Our objectives were to describe the frequency, risk factors, and consequences of delivering an infant with congenital syphilis among pregnant women with active syphilis. METHODS: In a retrospective record review using consecutive sampling of logs at maternity hospitals in five geographic areas, data were abstracted for 850 women with active syphilis during pregnancy who had completed >/=20 weeks' gestation. Further information was abstracted from records in antenatal clinics, dermatovenereology clinics, and paediatric hospitals. We assessed the frequency of confirmed or probable congenital syphilis, used logistic modelling to identify independent predictors for delivering a baby with congenital syphilis, and calculated the proportion of infants with congenital syphilis who experienced late fetal death (20-27 weeks), stillbirth (>/=28 weeks), or infant death. RESULTS: A total of 64% (n=544) of 850 pregnant syphilis infected women delivered an infant with confirmed or probable congenital syphilis; 40% of the sample had no prenatal care. Among women with no prenatal care, 77% received either no treatment or inadequate treatment and 86% delivered an infant with congenital syphilis. Important independent and modifiable risk factors for delivery of an infant with congenital syphilis included receiving no prenatal care (adjusted OR 2.8, 95% CI 1.7 to 4.7) and having the first test for syphilis at >/=28 weeks' gestation (adjusted OR 4.0, 95% CI 2.6 to 6.0). Fatal outcomes were observed in 26% of infants with congenital syphilis, including late fetal death (7%), stillbirth (16%), or neonatal death (3%). CONCLUSIONS: In the Russian Federation, the frequency of congenital syphilis is high, risk factors for congenital syphilis are modifiable, and the consequences of congenital syphilis are severe.

Transverse-momentum fluctuations in pi(+)p and K(+)p Collisions at 250 GeV/c.

We report results on event-by-event fluctuations of transverse momentum, Phi(p(t)), in pi(+)p and K(+)p collisions at 250 GeV/c. For the first time, their dependence on rapidity region, transverse momentum acceptance, multiplicity, mean transverse momentum per event, and on the correlation between transverse momentum and multiplicity are systematically presented. The results are compared with those from the PYTHIA Monte Carlo generator. The fluctuations under the same acceptance cuts as used in current heavy-ion experiments are also presented.

[Diagnosis of pulmonary lesions in acute respiratory insufficiency in patients with depressed hemopoiesis]. / Porazheniia lëgkikh pri ostroi dykhatel'noi nedostatochnosti u bol'nykh s depressiiami krovetvoreniia.

AIM: To analyse causes of acute respiratory failure (ARF) and methods of diagnosis of pulmonary lesions in patients with depressed hemopoiesis (DH). MATERIAL AND METHODS: 50 patients with DH and ARF were examined according to the protocol including x-ray, computed tomography, fibrobronchoscopy with bronchoalveolar lavage, cytological, bacteriological, virusological studies of the lavage fluid, biopsy of the lung. The algorithm of the protocol is provided. RESULTS: Sensitivity of the lavage fluid in diagnosis of fungal, bacterial, pneumocystic and cytomegaloviral infections was 84, 78, 93 and 93%, respectively. The cytologic examination of the lavage fluid may detect lung infiltration with blood tumors. In complicated diagnostic cases lung biopsy verified pulmonary lesion but its conduction aggravated the patients' condition. ARF patients with DH, bacterial flora, fungi, cytomegalovirus and pneumocystic infection, pulmonary tumor involvement, pulmonary lesions in ATRA-syndrome, non-infectious lesions of the lungs after bone marrow transplantation were found in 38, 18, 40, 18, 8 and 4% of cases, respectively. CONCLUSION: DH patients with ARF should be examined by the protocol including both non-invasive and invasive diagnostic methods. Accurate diagnosis of ARF causes is the basic reserve in the treatment of such patients.