[Optimization of enuresis therapy in children using transcranial magnetotherapy].

A total of 58 children (age from 6 to 14 years) suffering from nocturnal enuresis (NE) were divided into two groups. The study group received basic therapy (driptan dose was reduced to 2.5 mg twice a day) in combination with transcranial bitemporal magnetotherapy (TcMT). The control group received placebo TcMT and basic therapy. It is shown that addition of TcMT to reduced basic therapy lowered the score of imperative voiding symptoms 1.3-fold, number of enuresis patients 1.7-fold, volume of the bladder 6.8 months after the treatment 1.9-fold, corrected vegetative status and activity of the subcortical nervous center in 24% children according to cardiointervalography versus the controls. Thus, TcMT improves clinical effect in NE patients in 2-fold reduction of pharmacological burden.

[A contractile function of various megaureter forms in infants and its pharmacological regulation].

A total of 43 infants under 3 years of age with organic, functional and reflux obstructive megaureter were studied. The function of the upper urinary tract was examined with dynamic pyeloureterosonography with diuretic load. Contractility of isolated fragments of megaureters and possibility of its pharmacological regulation were studied in patients after surgery in vitro. Different urodynamic variants of the response of refluxing and obstructive megaureters and those with functional obstruction on stimulation of diuresis were established at dynamic pyeloureterosonography with diuretic load. The differences concerned the strength and kind of the reaction, frequency, amplitude and performance of the megaureters (15-30-45 min). In vitro studies confirmed functional differences between the forms of megaureters. The data obtained show preservation of functional reserves of the wall of the refluxing megaureter in children, suppression contractions and reaction of the megaureters with organic obstruction in the ureterovesical anastomosis while functionally obstructive megaureters are able to contract slowly and have reactivity according to the state of the smooth muscle wall. Pharmacological impact on ureteral function by metabolic drugs (picamilone) is determined. A direct action of lasix on the smooth muscle (weakening of high toxic reaction) is proved.

[Clinical significance of profilometry of the pyeloureteral segment in congenital hydronephrosis in children]. / Klinicheskoe znazhenie profilometrii pieloreteral'nogo segmenta pri vrozhdennom gidronefroze u detei.

Examination of hydrodynamic condition of the upper urinary tracts with step-by-step pyelomanometry and profilometry of the pyeloureteral segment in 26 children at the age of 6 to 14 years with hydronephrosis provided topical diagnosis of the obstruction level. The priority role of the pelvis in development of obstructive urodynamic disorders was ascertained in 9 children. In the rest 17 children urodynamic disorders were determined by a different degree of obstruction in the prepelvic ureter. This urodynamic study may be essential for design of new approaches to choice of treatment method in the context of pathogenesis of hydronephrosis development.

[The basic mechanisms of microcirculatory disorders before and during operations in children with developmental defects of the kidneys and urinary tract]. / Osnovnye mekhanizmy narushenii mikrotsirkuliatsii do i vo vremia operatsii u detei s porokami razvitiia pochek i mochevyvodiashchikh putei.

The authors studied biomicroscopic picture of microcirculation in the vessels of bulbar conjunctiva, renal hemodynamics, blood cell metabolism in 50 patients aged 3-12 with renal and ureteral defects. By morphology of the kidneys assessed at aortography, computer renangiography and other tests 2 groups of children were identified: bilateral congenital urological disorder combined with severe advanced dysplasia of the renal tissue and the ureter, low renal function (group 1); light or moderate disorder of renal function, minimal dysplasia of the renal tissue. In children with renal and urinary defects with renal dysfunction there was systemic abnormal microcirculation (group 1) characterized by severe capillarotrophic insufficiency in the form of unusual winding of all the microvessels, formation of vascular loops and balls, narrowing of capillary lumen, etc. in the presence of acute arteriolar spasm and rheological alterations in microvessels. In addition to functional changes in arteriolar tone, mechanisms of microcirculatory disturbances in children with congenital surgical disorders of the kidneys and urinary tracts involve membrane-destructive processes. Changes in phospholipids level and their spectrum in plasma and red cell membranes, a rise in the activity of phospholipase A and C in the serum and red cell membranes exhibit close correlation with microhemodynamic impairment. Instructions are provided for conduction of preoperative preparation and multicomponent anaesthesia with allowances for principal mechanisms of microcirculatory disorders in children with severe congenital renal and urinary affections.