[Current strategies of intermittent hormone therapy in prostate cancer].

Despite its side-effects, most of which are reversible, effectiveness of hormonal therapy in prostate cancer has been demonstrated. Advantages of intermittent hormonal therapy have been evaluated in a number of phase II clinical tests. As a result, side-effects were shown to decrease and quality of life improved. Preliminary phase III tests failed to detect any negative effect of intermittent hormonal therapy on tumor progression-free survival as compared with continuous hormonal therapy.

[Surgical tactics in acute epididymitis in children].

Differentiated surgical policy was applied in the treatment of 147 children aged under 18 years with acute epididymitis. Basing on laboratory, clinical and ultrasound characteristics, three treatment methods were used: conservative treatment, puncture of the scrotum, revision of the scrotum. Puncture treatment of acute epididymitis appeared effective in accurate diagnosis of indications for this therapy and due performance. Ultrasound potential is shown in differential diagnosis in acute scrotum syndrome.

[Surgical access for small-sized lung lesions].

Experience of diagnostics and surgical treatment of of 100 patients with small-sized lung lesions was analyzed. Thus, authors pose, that patients with lung focal lesion less than 10mm in diameter, should have a lung resection, performed from minithoracotomy. Videthotacoscopic lung biopsy is appropriate by multiple focal lesions. Patients with solitary peripheral lung lesion more than 1sm in diameter, should get a lung resection, performed from minithoracotomy with videoassistance. Patients with solitary lesion less than 5 mm in diameter requier radiological dynamic follow-up (CT-scan each 6 months).

[Choice of a drainage method in plastic reconstructive operations for congenital hydronephrosis in boys].

We analysed surgical outcomes in 41 boys aged 2.5 months to 17 years with congenital hydrohephrosis who were treated with external drainage (nephrostoma, intubation drainage, Gibbon's drainage) and by means of stenting. We discovered that stent drainage produces urethral traumas, orchitis, orchoepididymitis. Our study made us to recommend external drainage methods for boys with congenital hydronephrosis undergoing reconstructive plastic surgery to prevent injuries and inflammation in the urogenital system.

[Extracorporeal shockwave lithotripsy in the treatment of urolithiasis in children].

Extracorporeal shock wave lithotripsy (ESWL) was performed in 1451 children with urolithiasis aged from 7 months to 16 years. A total of 2464 sessions were made. Low-energy impulses in ESWL were effective in 98.8% children with concrements up to 2.0 cm in size and in 98.8% of those with stones larger than 2.0 cm. We believe that main factors of high efficiency of ESWL in children are: more friable structure of stones, small depth of stone location, faster evacuation of the stone fragments. ESWL with low energy impulses is highly effective and is not accompanied with traumatic complications. Renal parenchyma is not affected.

[Choice of a method of temporary drainage of the upper urinary tract in plastic reconstruction surgery on the vesicoureteral segment in children].

Among prevalent causes of abnormal urine outflow from the kidneys and urinary tract in children are neuromuscular ureteral dysplasia (NMUD) and vesicoureteral reflux (VUR). Many complications and unsatisfactory results of the treatment of the above conditions depend on the drain method. NMUD and VUR were surgically treated in 85 children (age from 6 months to 17 years, 39 boys and 46 girls). Treatment results were analysed with reference to the drainage method--catheter stent or intubation by findings of excretory urography, cystography, ultrasonography and morphological examination with evaluation of a morphological picture of ureteral muscular wall, stage of the disease and extention of the upper urinary tract. Criteria of drainage method choice were determined depending on age of the children, morphological data, NMUD stage and degree of VUR. In NMUD stage II and III and VUR degree 4 characterized by manifest changes of upper urinary tract contractility intubating drainage is more effective. In insignificant changes of ureteral contractility (NMUD stage I and VUR degree 1-3) internal stent is a method of choice. Thus, treatment outcomes in NMUD and VUR depend not only on surgical method but also on the method of drainage.

[Transurethral ureteropyeloscopy with lithotripsy and lithoextraction in children].

High efficacy of endoscopic treatment of urolithiasis in adults stimulated its introduction in the strategy of urolithiasis management in children. 133 ureteropyeloscopies with ureterolithotripsy and ureterolithoextraction was performed in 121 children (boys and girls, age 11 months to 16 years). Concrements (0.5-2.0 cm and larger) located in the caliceal-pelvic segment, ureter, 12 patients had bilateral urolithiasis. Ineffective extracorporeal lithotripsy (ELT) was followed by ureteropyeloscopy in 86 (71%) cases. Rigid and fibroureteropyeloscopes were used. Due to ureterolithotripsy and lithoextraction, concrements were removed completely in 98 (80.9%) patients including 5 children with ligature concrements and 11 children with ureteral strictures which required additional endoureterotomy and removal of ligature. In 23 (18%) cases when migration of concrements and their fragments did not allow complete elimination of the concrements, the kidney in ureteropyeloscopy was drained by catheters or stents with further ELT. Postoperative exacerbation of pyelonephritis treated conservatively was registered in 20 (16.5%) children. Long-term complications were not seen. Thus, transurethral uretheropyeloscopy with lithotripsy and lithoextraction is highly effective, low invasive, safe treatment of urolithiasis in children in failure of ELT.

[Endoscopic treatment of bilateral vesicoureteral reflux in children].

Endoscopic treatment of bilateral vesicoureteral reflux (VUR) was made in 8 boys and 28 girls (a total of 58 collagenizations in various modifications). Secretory function of the kidney was studied before surgery and obstruction of the vesicoureteral segment was excluded. Cystoscopic picture was analysed. The analysis of correlations between efficacy of antireflux collagenisation of the ureteral ostium and ureteral ostium position and shape, renal function leads to the conclusion that submucosal endoscopic collagen implantation in the abnormal ostium in its lateroposition is not effective. This was confirmed by pathomorphological investigations of VUR which discovered dramatic impairment by smooth muscle atrophy type with fiber dyscomplectation, perimuscular sclerosis. Thus, endoscopic treatment of bilateral VUR in children is safe, but its efficacy depends on valid choice of indications. In congenital VUR caused by dysplasia of vesicoureteral segment a preferable treatment is ureterocystoanastomosis.

[Assessment of metabolic disturbances risk factors in urolithiasis children with questionnaire survey].

Risk factors of metabolic disturbances in children with urolithiasis were studied in 38 children aged 1.7 to 14 years. The information for the disease history was obtained from the parents of the children participating in the study. The parents filled in special questionnaire which has detected that 14.2% of fathers and 72% of mothers had chronic diseases; when pregnant, 81.5% mothers had toxicosis and gestosis, 23% suffered from various viral and bacterial infections treated for a short time with drugs; 63% mothers did not keep diet before pregnancy but pregnancy and lactation made 77% of them pay due attention to their food and diet regime. Breast feeding lasted for the first 2-6 and 1-2 months in 38 and 50% mothers, respectively. Feeding was mixed from birth in 23% babies. Development of metabolic disturbances in children leading to urolithiasis depends on many factors closely linked with environment pollutants, life style of the parents, gynecological health of mothers, intercurrent diseases. Immunogenetic, hereditary mechanisms are involved in triggering urolithiasis in children.

[Intraoperative ultrasound investigation and laser spectroscopy for diagnosis of cancer in patients with lung tumors].

The experience in more than 2000 surgeries on the lungs is analyzed. Recently intraoperative ultrasonic and laser autofluorescent spectroscopic revision of tumors of the lungs and mediastinal organs is successfully used. Intrasurgical ultrasonic examination of the lungs permits to detect the structure and diffusion of primary lung tumor (invasion of vessels) that influences policy of treatment. Optical spectroscopy permits one to carry out intraoperative rapid diagnosis of benign and malignant lung tumors.

[Extravesicle ureterocystoanastomosis]. / Ekstravezikal'nyi ureterotsistoanastomoz.

Extravesical ureterocystoanastomosis without wide opening of the urinary bladder was practised since 1986. A total of 79 patients were operated: 71 children at the age from 1 to 14 years and 8 adults aged 14 to 58 years. Surgical intervention was performed on 112 ureters for vesicoureteral reflux and supravesical ureteral obstruction. 6 of 79(7.6%) patients on postoperative day 11-15 after removal of intubating drains had an attack of acute pyelonephritis. 3 of these 6 patients were reoperated with a good effect, in 2 patients urine passage recovered 2-3 months after removal of transcutaneous puncture nephrostoma. In one child this technique was used for the first time at the third operation on vesicoureteral anastomosis. This prevented subsequent removal of the nephrostomic drain because of vesicoureteral reflux in the presence of severe irreversible retention changes of both ureters. The advantages of the above technique are reduced operative injury, no contraindications in primary operations and reoperations, feasibility in various forms of vesicoureteral anastomosis failure. This makes the technique of extravesical ureterocystoanastomosis rather promising.

[Study of dimerization of polysynthetic derivatives of the antibiotic eremomycin by ESI MS and its role in elucidating antibacterial activity]. / Izuchenie dimerizatsii polusinteticheskikh proizvodnykh antibiotika éremomitsina metodom ESU MS i ee rol' v proiavlenii antibakterial'noi aktivnosti.

The dimerization constants for glycopeptide antibiotics vancomycin, ristocetin, and eremomycin and nine semisynthetic eremomycin derivatives were determined by the electrospray ionization mass spectrometry; the constants for natural antibiotics turned out to be close to those previously determined by NMR. No correlation between these dimerization constants and antibacterial activities of all the compounds toward the clinical strains of Gram-positive bacteria was found.

[Chemical modification of glycopeptide antibiotics]. / Khimicheskaia modifikatsiia glikopeptidnykh antibiotikov.

New methods for the chemical modification of clinically important glycopeptide antibiotics are reviewed. Special emphasis is placed on chemical modification of the domestic antibiotic eremomycin, which has a number of advantages over the clinically used antibiotics vancomycin and teichoplanin. The most promising methods for glycopeptide modification at the aromatic ring and carboxyl group of the seventh amino acid of the peptide core and also at the amino groups of the carbohydrate moiety are discussed in detail. The structure-activity relations in a series of glycopeptide derivatives are revealed. It is shown that the presence of lipophilic substituents of certain structures and sizes is mandatory for activity toward glycopeptide-resistant enterococci to be displayed. The possibility of dimerization and interaction of these derivatives with membrane components of the bacterial cell wall is discussed. The structures of the derivatives most active toward glycopeptide-resistant enterococci and meticillin-resistant staphylococci are presented.

[Non-natural aglycones of glycopeptide antibiotics of the vancomycin group. Synthesis and antibacterial activity]. / Neprirodnye aglikony glikopeptidnykh antibiotikov vankomicinovoi gruppy. Sintez i izuchenie antibakterial'noi aktivnosti.

A new approach for the modification of the heptapeptide core of glycopeptide antibiotics was proposed based on the replacement of amino acid residues in positions 1 and 3 in teicoplanin aglycone and in position 1 in the eremomycin aglycone. Six novel nonnatural aglycones of the vancomycin type were obtained. Compounds derived from the teicoplanin aglycone exhibited in vitro activity against Gram-positive bacteria, and two of them were also active against the vancomycin-resistant enterococci.