The prospects for the use of a Soviet apparatus for the removal of gallstones with focused shock waves]

Clinico-experimental substantiation was conducted for extracorporal crushing of the stones in biliary ducts in patients who suffered from gallstone disease. The "Urat-II" national lithotriptor and "Urat-B" biostand were used to crush in experimental conditions 140 gallstones (0.5-2.5 cm in size) obtained during cholecystectomies. Experimental researches on 56 white rats were conducted to study the liver tissue and adjacent organs. Optimal regimes for the percussive wave generator were found out in which the best crushing effect was obtained (with the dimensions of fractions up to 1.6 mm) and at the same time the minimal disturbing factor was produced. The data obtained during these researches are used in clinical pilot testings on "Urat-II"--a prototype of the national cholelithotriptor.     

Use of a three-component scheme of immunosuppression on morphologic and immunohistochemical changes of transplants in the early postoperative period

Three-component (cyclosporin A, corticosteroids and azathioprine) immunosuppression has been widely introduced in the treatment of recipients of renal transplants because it allows a significant reduction of the components' doses in greater effectiveness. The analysis of the results of 83 puncture biopsies obtained in the immediate postoperative period after kidney transplantation has shown that administration of an imidazole derivative allows raising therapeutic concentration of cyclosporin up to 200-300 ng/ml, thus preventing rejection crises. However, increased blood concentration of cyclosporin does not increase its toxicity as a result of a significant fall in the overall level of the metabolites.     

Gastrointestinal hemorrhage in urological diseases

The authors analyse 28 cases of gastrointestinal hemorrhage (GIH) in urological diseases and after uronephrological operations, emphasize factors of uremic intoxication and relevant complications provoking DIC syndrome. Various factors leading to stress (acute blood loss, shock, sepsis) and development of immunodeficiency disturbed morphostructure of gastric and duodenal mucosa and provoked hemorrhage which was stopped most efficiently by fibrogastroduodenoscopy with coagulation of the bleeding vessel. If this operation failed, open surgery was performed. Conservative measures consisted in DIC syndrome management policy.     

Dynamics of the cause of death of the Saratov region population

Short-term fluctuations in mortality are analyzed for the Saratov region in order to indirectly evaluate the efficiency of public health. Analysis revealed new tendencies in population deaths, which however manifested not so clearly as was expected. Studies and prediction of short-term fluctuations in the mortality coefficient from causes of death remain an important problem.     

Lymphangioleiomyomatosis of the retroperitoneal space

The clinical course and the results of histological examination of retroperitoneal lymphangioleiomyomatosis in a woman of 32 are presented. The main morphological features of the disease were as follows: localization of tumour cells around the vascular spaces, accumulation of mature lymphocytes in the vascular spaces and among tumour cells, pronounced argyrophilic carcass of the tumour.     

Endoscopic correction of neuromuscular ureteral dysplasia in children

The authors present pathogenetic rationale for using endoscopic intervention in neuromuscular ureteral dysplasia in children. A positive effect of this treatment occurs primarily in patients with a small area of sclerosis focus in the ureter. Such patients have high percentage of leiomyocytes with a great regenerative potential. This explains a response to endoureterotomy.     

Intraprostatic injection of 96% ethanol in experimental animal model

Transurethral intraprostatic injection of ethanol (IIE) is a new low-invasive method in the treatment of benign prostatic hyperplasia (BPH). We made dog and rat experiments to prove safety and efficacy of IIE. The experiment was made on 10 rats and 10 dogs injected transurethrally (Prostaject device) with 96% ethyl alcohol in 10% volume of estimated volume of the prostate. The injection was followed by measurement of blood alcohol, the test for hemolysis. Transurethral ultrasound control of prostate size 1, 3 and 6 months after the injection and histological examinations 1, 3, 7, 14 days and 1, 3 and 6 months after the injection were made. It was found that blood alcohol after the above injection was not elevated. Necrosis was documented in all the cases but subsequently the necrotic site was replaced with sclerotic tissue. The necrosis involved only the prostatic capsule. The size of the prostate diminished by 29%. Thus, transurethral injection of ethyl alcohol (10% of prostate size) is safe and effective in achievement of prostatic gland ablation. Therefore, clinical trials of the method in patients with benign prostatic hyperplasia are justified.     

Morphological changes in prostatic tissue of patients with benign prostatic hyperplasia treated with permixon

A pilot trial has been performed to assess effects of permixon on prostatic tissue in patients with benign prostatic hyperplasia (BPH). A total of 49 BPH and control patients entered the trial. 36 patients of the study group were randomized into 3 subgroups of 12 patients each. Permixon was taken in a standard dose of 320 mg/day for 3, 6 and 12 months, respectively. Mean duration of BPH was 3.7 years (0-8 years). Mean value of PCA was 6.0 ng/ml. The control group of 13 patients were not given permixon. Multifocal prostatic biopsy was performed in all the patients before and after the treatment or follow-up. Stromal-parenchymatous correlation in the study group significantly increased (by 59%)--from 3.28 (0.25-9.61) to 5.22 (1.20-10.67) (p = 0.0002). For the control group this correlation was insignificant. Permixon-treated patients demonstrated inhibition of prostatic epithelium proliferative activity by 32% (p = 0.0001) and a rise in the stage of proliferative centers development from stage II-III to IV-V. Intensity of inflammation in prostatic tissue decreased by 53% in the study group and insignificantly in the control group. Thus, permixon treatment of BPH leads to a significant rise in stromal-parenchymatous correlation due to inhibition of proliferative activity of prostatic epithelium and attenuation of inflammation.     

Liver pathology in patients with primary hemochromatosis--homozygous carriers of C282Y mutation

Liver pathology was studied in 3 patients with primary chemochromatosis. In two cases so-called iron free foci with signs of hepatocytes with feature of dysplasia were found. Many siderosomes were found ultrastructurally in the cytoplasma of hepatocytes. Histological markers of virus infection were absent in a patient with positive serum HbsAg and HCV-Ab. Alcohol did not produce typical histological changes. In this case grave liver reticuloendothelial hemosiderosis typical for secondary hemochromatosis and overloading with iron of spleen pulp according to MR imaging were observed.     

Accelerated fractionation regimens in radiotherapy of inoperable non-small-cell lung cancer

The results of definitive radiation treatment (1988-2000) for 375 patients with inoperable non-small cell lung cancer were analyzed. Three regimens of fractionation were used: (1) accelerated fractionation (AF)--(133), 2.5 Gy, 3 days a week, to a total of 47.5--55 Gy; (2) accelerated hyperfractionation (AHF)--(93), 1.25 Gy, daily, to a total of 60-72.5 Gy and standard fractionation (SF)--(149), 2 Gy, daily, to a total of 58-68 Gy. The advantages of AHF were established as regards complete regression rate (54.9% vs. 18.6%--SF and 18.1%--AF; p(0.001), median survival (30.5(2.4 months vs. 18.9 (1%--SF (p = 0.004) and 20.4 (2.4--AF (p = 0.004)), and 3-year survival (36.6% vs. 16.7%--SF (p = 0.005) and 15.5%--AF (p = 0.005). 17.9%, 9.0% (p = 0.11) and 8.1% (p = 0.08) have survived, respectively. Overall survival in the AHF group was superior in stages IIB--III; in stage I, the results were identical. Immediate response to radical radiotherapy appeared the only statistically significant factor of survival (p = 0.005-0.008) in all the groups.