[Evaluation of the association of polymorphisms of the CYP2C8 gene with the efficacy and safety of ketorolac in patients with postoperative pain syndrome].

AIM: To evaluate the possible association of CYP2C8 gene polymorphisms with the clinical efficacy and safety of ketorolac in relation to postoperative pain. MATERIALS AND METHODS: The study included 107 patients after video laparoscopic cholecystectomy, who received ketorolac (30 mg 2.0 w/m 3 r/d) as postoperative pain relief. All patients were genotyped for CYP2C8. The pain syndrome was assessed using the visual analog scale, the McGill pain questionnaire. The profile of adverse reactions was assessed by the dynamics of red blood counts, as a possible trigger for the development of gastrointestinal bleeding according to the method of global assessment of triggers (Global Trigger Tool GTT). RESULTS: According to visual analog scale data: in carriers of the genotype CYP2C8*3 (rs10509681) and CYP2C8*3 (rs11572080) after 12, 24, 36, 48 hours the intensity of pain syndrome is lower than in carriers of the wild type (p0.05). According to the McGill pain questionnaire, there were no statistically significant differences in pain intensity between the two groups. CONCLUSION: In carriers of the genotype CYP2C8*3 (rs10509681) and CYP2C8*3 (rs11572080), the effectiveness of anesthesia with ketorolac is higher than in carriers of the wild type. Carriage of the genotype CYP2C8*3 (rs10509681) and CYP2C8*3 (rs10509681) does not affect the risk of developing adverse reactions after ketorolac anesthesia.

[Water-electrolyte homeostasis and hemostasis system after transurethral resection of the prostate].

Changes in coagulogram and water-electrolyte homeostasis were studied in 89 patients surgically treated for prostatic adenoma (TUR). The patients were divided into 2 groups: group 1 (n=21) was operated with use of distilled water, group 2--with 5% glucose solution. The following examinations were made in all the patients: extended coagulogram, total blood count, concentration of electrolytes, creatinin, plasma urea and glucose, osmolality measurements. These were made thrice: before the operation, on postoperative day 1, postoperative day 3. Postoperative changes of hemostasis and water-electrolyte homeostasis of plasma were less significant in group 2. The risk of postoperative hemorrhage is higher in patients of group 1.

[Rentgenoendoscopic surgery of the complicated forms of urolithiasis with accompanying diabetes mellitus].

The successful application of endoscopic contact lithotripsy and nephrolithoextraction allows saving the patients from staghorn stones without having recourse to traumatic open surgical modalities. Percutaneous removal of staghorn stones with the use of rigid-lens nephroscopes presents as an effective and less-invasive treatment option with minimal amount of intra- and postoperative complications, which is particularly important in case of presence of accompanying diabetes mellitus.

[Characteristic of cytopathological changes in urine after extracorporeal shock wave lithotripsy].

The aim of the study is to assess the damage to the urothelium caused by shock waves through cytological examination of the urinary sediment in patients who had ESWL. Study included 100 otherwise healthy first-time stone-formers aged 20 to 50, who underwent ESWL on Modulit SLK machine. Urinary samples were taken before and immediately after ESWL, in two days and on the fourth day after ESWL. Control group included 20 healthy individuals. The urine was centrifuged, smears fixed by conventional MGG method and stained by azure-eosine using Pappenheim's method. Cytogram data analysis was performed using morphometric methods, allowing for qualitative and quantitative cell characteristics be translated into digital form. Student t-criteria was used for statistical evaluation of the difference of derived figure parameters. The authors put the stress on destructives processes. In order to rule out biased assessment of the cytograms, morphometric examination of urinary sediment was performed. Averaged value of the total cell index was calculated with one of the forms of cytopathology and deduced heterogeneity of cytological indices within a particular group X(cell)/ Σep (X(cell) where is the average value of the total cell index with one of the forms of cytopathology within the whole sampling, Sep is the total number epithelial cells). The sum of absolute indices of cytological changes is considered as "destruction index" (DI), which reflects accumulated pathological changes in epithelial cells: DI=X(1)/Σep + X(2)/Σep Immediately after ESWL a statistically valid (p<0.01) significant increase in DI is registered. In two hours after the session DI is decreased, but remains rather high, and almost normalizes by the fourth day. We also explored the specificity particular for each term of examination, expressed by cytological changes. Examination of indices of heterogeneity within a group with moderately expressed destructive changes (X(1)/Σep) revealed that these digital values even in healthy men are slightly above zero (0.15 ± 0.03). Just after ESWL values rise to 0.6 ± 0.1, then slowly decrease to 0.4 ± 0.1 (2 hours after) and 0.25 ± 0.07 (four days after). As to parameters specific to deep cellular changes (X(2)/Σep), it is equal to zero healthy men, rises after ESWL, then decreases in two hours and almost normalizes by fourth day. Digital values for this parameter are several orders lower than for parameters of cells with moderate changes. Study results indicate that epithelial lining of the upper urinary tract undergoes cytopatho-logical changes of different degrees, still they are of transitory and reversible nature, which is proven by urinary sediment cytogram performed on the fourth postprocedure day.

[Alfa-blockade with doxazosin vs tamsulozin in combination of intermittent androgen blockade in patients with prostate cancer].

We have studied the efficacy of Alfa-blockade with Doxazosin vs Tamsulozin in combination with Intermittent Androgen Blockade (IAB) in patients with low grade prostate cancer. Our clinical trial included: I group (n=15) of patients who received doxazosin with IAB and flutamide; II group (n=13) of patients who received tamsulozin in combination with IAB and flutamide and III (n=33) group with flutamid monotherapy alone. Our results have shown that the combination of doxasozin and IAB with the flutamide leads to the better improvement of uroflowmetry and IPSS parameters, whereas the tamsulozin and IAB with flutamide combination induce those improvements for the longer period during the disease remission.