No 5 (2014)

Modern health care is impossible to imagine without the constant development of the methodology of treatment; a fundamentally new methods or devices are often developed. In this case, there are many reasons for the need to protect copyright, and it is easy. The article describes: how and what can be patented, what are the main features and complexity of the organization of this process, what is needed to do this specifically? Actual examples are presented.

Studies have shown that complicated chronic pyelonephritis in the active phase is characterized by structural and functional instability cytomembranes and decreased immunological resistance of the patient man. Supplement standard antibiotic treatment with ozone therapy antioxidant immunomodulation drug thus received immuno-biochemical study .

The anatomical study of 188 retroperitoneal organocomplexes by direct methods of measurement and nonparametric Spearman correlation analysis explains the significance of different types of right cavatesticular and renotesticular communications in the genesis of expansion of right testicular vein. In 74% of cases, right testicular vein (TV) ends in the inferior vena cava (IVC), and in 26% of cases - in the right renal vein (RRV). When TV ends in IVC, quantity anomaly (doubling TV) is observed in 6.94% of cases; when TV ends in RRV, such anomaly is observed in 40.9% of cases. The width of right TV in the case of its end in IVC was 3.39 ± 0.1 mm, and left TV - 2.95 ± 0.1 mm (n = 144), ie, right TV 0.5-1 mm wider than the left TV (P = 0.0008). Correlation analysis showed a weak relationship between the width of the right TV and lack of ostial valve at the end in IVC (r = -0.16, n = 144, P = 0.05). Associations of width of right TV with other factors (lack of ostial valves in the end in RRV, high location of RRV, width of the RRV, angle of return of TV to RRV, deposition of TV entry to the hilum of kidney or IVC) have not been reliably established. The moderate relationship between the width of right TV and type of entry of right inferior segmental renal vein in TV was established (r = 0.63; n = 6; P = 0.05). In a study, among all types of macroanatomical relationships with right TV, a single variant with important role in ectasia of TV was revealed - an entry of inferior segmental renal vein in the retroperitoneal segment of right TV.

Chronic recurrent cystitis in women is a major socio-economic problem. In the pathogenesis of recurrent infection, violations of mechanisms of innate immunity of the bladder mucosa, and the persistence of microorganisms play an important role. The study included 43 women (mean age 39.5±1.2 years) with persistent lower urinary tract infection. The mean duration of disease was 6.5 ±1.8 years. Depending on the therapy, patients were divided into two groups. Patients in Group 1 (n = 20) have received only fosfomycin trimetamol 3 g every 10 days for 3 months, patients in group 2 (n = 23) have received the drug viferon® (rectal suppositories) 1 million IU per rectum 2 times per day at intervals of 12 hours for 20 days in addition to antibiotic therapy at the same dosage. The inclusion of immunomodulator in the complex therapy of persistent lower urinary tract infections contributed to the reduction of relapse rate by 1.5 times, and reduction of the number of patients with relapses by 4 times.

The first part of the article discusses the technical details of the magnetic resonance spectroscopy (MRS) of the prostate, postprocessing and assessment of the results; the second part of article presents a several own clinical examples, and describes the advantages and disadvantages of the methodology. Of all available clinical MRI techniques for the evaluation of the prostate multivoxel spectroscopy is the most difficult. Thus, even with abidance of all the technical aspects of the evaluation, it impossible to be sure absolutely that qualitative range of voxels of interest will be received. Upon receipt of quality results with interpretable spectra, it is still difficult to perform the differential diagnosis of cancer with benign changes. These complexities limit the widespread use of prostate MRS. In our opinion, the use of this method is most effective for a diagnosis of cancer localized in the peripheral zone of the prostate, and for the assessment of the dynamics of non-surgical treatment of the tumor.

The evaluation of potential anti-TB activity and bactericidal activity against opportunistic enterobacteria in urine of healthy people using the automated BACTEC MGIT 960 system for cultivation and determination of drug resistance of mycobacteria and culture on solid media was performed. It has been established that the urine of healthy people do not have bactericidal activity against M. tuberculosis and E. coli in vitro. The one of the possible reasons for the low detection of the pathogen in urogenital tuberculosis - asymptomatic bacteriuria - was identified.

The epidemiological study in Vladivostok and Primorye Territory in period 1999 to 2013 was performed. In the structure of cancer incidence at the evaluated areas, renal cancer occupies fifth place among male population (5.7 and 5.3%, respectively), and 11th place (3.5%) among female population. The problem of renal cancer in this region and the administrative center is relevant due to the increasing incidence: a standardized measures in the period of 2009-2013 were 12.5 ± 0.3 and 11.7 ± 0.50/0000, respectively. The Increase of the incidence can be explained by the integrating influence of complex of changing demographics and health, social, hygienic and other factors. The questionnaire survey has become one of the main methods to identify risk factors for the development of the disease. Risk factors for renal cancer were identified by the «case - control» method. 231 patients with renal cancer (mean age 58.2 ± 1.7 years) and 354 healthy men and women (mean age 57.4 ± 2.2 years) underwent questionnaire survey. Specific risk factors for renal cancer were identified: migration (OR = 1.6, P = 0.0149); low socio-economic status (secondary-level education, income per family member less than 10,000 rubles, OR = 1.5, P = 0.0349); started smoking before 18 years of age (OR = 1.5, P = 0.0349); trade with physical activity and occupational hazards (car drivers, sailors, house-painters, OR = 2.0, P = 0.0000); occupational hazard: contact with oil products (OR = 1.6, P = 0.0262), contact with lead, asbestos, dyes (OR = 3.5, P = 0.0000); length of time worked with occupational hazard over 5 years (OR = 1.6, P = 0.0126); occupational hazard in the form of an underground work (OR = 8.0, P = 0.0000) and the presence of large amounts of dust (OR = 1.2, P = 0.0381); location of industrial enterprises within 2 kilometers from homesite (OR = 2.5, P = 0.0000). Based on the identified risk factors, predictive model for the assessment of individual risk and the formation of groups at risk for renal cancer was developed.

The study was aimed to the improvement of the diagnosis and treatment of patients with prostate cancer (PC). The study included 46 patients with recurrent prostate cancer after radical prostatectomy (RPE). The examination included contrast enhanced magnetic resonance imaging (endorectal coil 1.5T) and hystoscanning. All patients had local recurrence confirmed by the morphologically results of transrectal biopsy of the area of vesicourethral anastomosis. All patients underwent high-intensity focused ultrasound (HIFU). Before RPE, protate volume ranged from 21 to 102 cm3. The median age was 62 (46-68) years. PSA levels before a HIFU session ranged from 0.4 to 18 ng/ml. Nadir PSA level after 3 months of follow up was 0.1 ng/ ml. Five-year disease-free survival in patients with locally recurrent prostate cancer after HIFU in the group of low cancer risk was 10 (81%), moderate risk - 18 (57%), high risk - 12 (42%). Contrast enhanced magnetic resonance imaging and hystoscanning are highly informative methods for diagnosis of local recurrence after radical prostatectomy, and HIFU can be categorized as highly effective treatment.

Immunohistochemical evaluation of localization of matrix metalloproteinase-9 (MMP-9) and an inhibitor of matrix metalloproteinase-1 (TIMP-1) and cell proliferative activity in the production Ki-67 protein in benign prostatic hyperplasia (BPH), and adenocarcinoma with different Gleason scores was performed. Moderate positive correlation between the Gleason scores and cell proliferation index usind Ki-67 antigen (rs = 0.674), moderate negative correlation between Gleason scores and levels of MMP-9 production (rs = -0.660), and weak significant negative correlation between the levels of cell proliferative activity and MMP-9 production by tumor cells (rs = -0.369) were established. Invasive properties of tumor cells, expressed in the destruction of type IV collagen in basement membrane and connective tissue of the stroma of the prostate, are associated with imbalance in MMP-9 protein, and blocking enzyme, TIMP-1; and TIMP-1 production is reduced significantly in adenocarcinomas with different Gleason scores compared with BPH.

The article presents the results of the study including 60 patients with erectile dysfunction, divided into four age groups: 20-30, 31-30, 41-50, and 51-60. All patients have received biocomplex “NeiroDoz” for two months 2 capsules 2 times a day. Clinical effectiveness was evaluated according to the ICF and ICEF questionnaires and according to the patient’s subjective evaluation of the clinical efficacy; the psycho-emotional status of patients and changes in the chronograms were also analyzed. In all men with erectile dysfunction, pronounced desynchronosis and psycho-emotional disorders were revealed. The use of complex “NeiroDoz” allowed to correct erectile disorders and psycho-emotional status of patients, as well as to restore normal chronorithms in all groups of patients, regardless of age and severity of erectile dysfunction.

The one of the most common defects of the ureter-vesical segment in children is the condition, leading to a disorder of obturative function of this segment. CompIications of vesicoureteral refIux incIude continuousIy recurrent pyeIonephritis, refIux nephropathy. In this regard, the choice of the optimal treatment strategy based on minimal invasion is considered as one of the priorities of pediatric urology. The article presents the data obtained during the treatment of VUR in children of different ages in the Clinic of Reproductive Health FSBSI SCCH. A comparative evaluation of the results of endoscopic correction of vesicoureteral reflux depending on the kind of the bulking agent was performed. It was found that the use of endocorrection of reflux is highly effective surgical procedure, with the high number of positive results against the background of use of bulking agent «vantris». The study discriminates a group of patients with vesicoureteral reflux, intractable for endoscopic correction with cystoscopically normal structure of the orifices that allows to refer this method to the initial stage of treatment of the disease.

The study was aimed to the evaluation of the effectiveness and results of ultrasound guided percutaneous nephrolithotripsy (PNL) for the treatment of patients with large stones in renal pelvis. The results of PNL in 138 patients who underwent surgery for kidney stones from 2011 to 2013 were analyzed. Seventy patients (Group 1) underwent surgery with combined ultrasound and radiological guidance, and 68 patients (Group 2) - only with ultrasound guidance. The study included patients with large renal pelvic stones larger than 2.2 cm, requiring the formation of a single laparoscopic approach. Using the comparative analysis, the timing of surgery, the number of intra- and postoperative complications, blood loss and length of stay were evaluated. Percutaneous access was successfully performed in all patients. Postoperative complications (exacerbation of chronic pyelonephritis, gross hematuria) were observed in 14.3% of patients in Group 1 and in 14.7% of patients in Group 2. Bleeding requiring blood transfusion, and injuries of adjacent organs were not registered. Efficacy of PNL in the Group 1 was 95.7%; 3 (4.3%) patients required additional interventions. In Group 2, the effectiveness of PNL was 94.1%, 4 (5.9%) patients additionally underwent extracorporeal lithotripsy. There were no significant differences in the effectiveness of PNL, the volume of blood loss and duration of hospitalization. Ultrasound guided PNL can be performed in large pelvic stones and sufficient expansion of renal cavities, thus reducing radiation exposure of patients and medical staff.

Currently, there is accumulated mass of data on the molecular-genetic disorders in prostate cancer (PCa), bladder cancer (BC) and renal cancer (RC). Tumor cells in these diseases are present in the urine sediment; their number is sufficient for molecular genetic analysis that makes possible the development of noninvasive diagnosis of oncourological diseases. A characteristic feature of PCa includes the overexpression of the PCA3 gene; assay kit Progensa™ to quantify such overexpression has been developed; approximately 50% of tumors express a TMPRSS2-ERG chimeric oncogene. Combined analysis of PCA3 and TMPRSS2-ERG allows to detect PCa with a diagnostic accuracy of 84%, which is significantly higher than that of prostate specific antigen test. As a potential markers of BC, there are somatic mutations in FGFR3, PIK3CA, TERT genes in urine sediment, which are found in this disease with a frequency of about 60, 30 and 50%, respectively. The basis of the test system for DNA diagnosis of BC in urine sediment may include a definition of a combination of mutations in these genes with microsatellite instability. Aberrant methylation of the 5'-regulatory regions of tumor suppressor genes, integrated in the panel, also is considered as a tool in the diagnosis of RC (VHL, RASSF1, RARB2, CDH1), PCa (GSTP1, PTGS2, LGALS3) and BC (RASSF1, APC, SFRP2) after standardization of panels of loci investigated, sample preparation methods, bisulfite conversion, and the design of primers and probes. Thus, a test systems for molecular genetic diagnosis of oncourological diseases in urine sediment are currently available or may be developed in the near future.