THE ROLE OF THE APPARENT DIFFUSION COEFFICIENT OF THE BIPARAMETRIC MRI AS AN IMAGING MARKER OF PROSTATE CANCER. / ROL' VYMIRIuVANOGO KOEFITsIIeNTA DYFUZIÏ BIPARAMETRYChNOÏ MRT IaK PROMENEVOGO MARKERA RAKU PEREDMIKhUROVOÏ ZALOZY.

Prostate cancer (PCa) is the most common malignancy in men. The role of the apparent diffusion coefficient (ADC)of biparametric MRI (biMRI) which is a study without the use of dynamic contrast enhancement (DCE), in detectionof PCa is still not comprehensively investigated. OBJECTIVE: The goal of the study was to assess the role of ADC of biMRI as an imaging marker of clinically significant PCaMaterials and methods. The study involved 78 men suspected of having PCa. All patients underwent a comprehensive clinical examination, which included multiparametric MRI of the prostate, a component of which was biMRI. TheMRI data was evaluated according to the PIRADS system version 2.1. RESULTS: The distribution of patients according to the PIRADS system was as follows: 1 point - 9 (11.54 %)patients, 2 points - 12 (15.38 %) patients, 3 points - 25 (32.05 %) patients, 4 points - 19 (24.36 %) patients and5 points - 13 (16.67 %) patients. In a subgroup of patients with 5 points, clinically significant PCa was detected in 100 % of cases. In the subgroup of patients with tumors of 4 points clinically significant PCa was diagnosed in 16of 19 (84.21 %) cases, and in 3 (15.79 %) patients - clinically insignificant tumor. In the subgroup of patients with3 points, clinically significant PCa was diagnosed in 11 of 25 (44.0 %) cases, in 8 (32.0 %) patients - clinicallyinsignificant tumor and in 6 (24.0 %) patients - benign prostatic hyperplasia. PCa with a score of 7 on the Gleasonscale showed significantly lower mean values of ADC of the diffusion weighted MRI images compared to tumors witha score of < 7 on the Gleason scale: (0.86 ± 0.07) x 103 mm2/s vs (1.08 ± 0.04) x 103 mm2/s (р < 0.05). CONCLUSIONS: The obtained results testify to the high informativeness of biMRI in the diagnosis of prostate cancer.The use of ADC allowed to differentiate clinically significant and insignificant variants of the tumor, as well asbenign changes in prostate tissues and can be considered as a potential imaging marker of PCa.

THE PECULIARITIES OF ARGINASE PATHWAY OF L-ARGININE IN SPERMATOZOA IN MEN WITH DIFFERENT FORMS OF PATHOSPERMIA.

The changes in arginase activity of spermatozoa and hormonal profile of peripheral blood of infertile men with various forms pathospermia have been studied. It has been found that arginase activity in the sperm cells of men with oligozoo-, antenozoo-, oligoastenozoo- and leucocytospermia is decreased in 2.1, 2.3, 2.4 and 3.3 times respectively. This indicates about inhibition of arginase pathway of L-arginine metabolism, which is not significantly dependent on the type of disruption of spermatogenesis. The most significant changes have been observed in infertile men with leucocytospermia since white blood cells stimulate the formation of reactive oxygen species, induction and development of oxidative and nitrative stress in spermatozoa. Inhibition of arginase pathway of L-arginine metabolism has adaptive role, which is to limit bioavailabil- ity of L-arginine and to prevent excessive formation of NO in cytotoxic concentrations to sperm cells. It has been noted changes in serum concentrations of gonadotropin and sex hormones in men with various forms of pathospermia. The most expressed significant changes were in levels of follicle stimulating hormone and testosterone. The concentration of follicle stimulating hormone in patients with oligozoospermia caused by hypogonadism is twice higher and in patients with leucocytospermia in 1.8 times higher than in fertile men. In patients with astenozoospermia this value is in 2.2 times lower than in normozoospermic samples but within the physiological norm. The testosterone level in men with oligozoospermia is in 1.6 times lower than in fertile men but within the physiological norm. It has been found that arginase inhibition of spermatozoa po6itively correlated with a decrease in their concentration in the ejaculate of infertile men with oligozoospermia (r =0.68).

SUBSTANTIATION OF THE METHOD OF TREATMENT CHOICE FOR PATIENTS, SUFFERING CALCULI OF THE LOWER CALICES RENALES.

Results of treatment of 276 patients, suffering the lower renalis calyx (LRC) calculi, hav' ing size (1.14 ± 0.35) сm, were analyzed. Depending on acuteness of іnfundibulo­ pelvic angle (ІPA) the examined persons were divided on groups with blunt (n=118) and acute (n=158) IPA; 8 аnatomic parameters of the LRC were in total determined. There was established, that еxtracorporal shock­wave lithotripsy, in accordance to the cal' culated index of a LRC calculis elimination, is expedient to apply in a bigger ІPA, lesser іnfundibulo­lumbar angle, lesser length of the LRC neck; transcutaneous nephrolithotripsy is effective not depending from a calculi dimensions, length of the LRC neck, value of ІPA and infundibulo­lumbar angle.

[Changes of microcirculatory bed after laparoscopic and open pyeloplasty for stricture of pyeloureteral segment].

Comparative characteristic of the vascular microcirculation indices was adduced in 49 patients, operated on in 2008 - 2013 yrs for stricture of pyeloureteral segment on the base of surgical centre of Scientific--practical Centre of prophylactic and clinical medicine and urological department of Lviv rural clinical hospital. The method of biomicroscopy and microphotography of conjunctiva was applied preoperatively, on a 5th and 14th days postoperatively with determination of vascular, intravascular, extravascular and common conjunctival indices. There was established, that after laparoscopic pyeloplasty the changes in vascular and coagulation systems in patients, suffering hydronephrosis, are less expressed (it is mostly representative on the 5th day), what reduces significantly a potential danger for intravascular thrombosis occurrence.

[Arginase and NO-synthase pathways of L-arginine metabolism in peripheral blood lymphocytes of patients with ovarian cancer].

The peculiarities ofarginase and NO-synthase pathways of L-arginine metabolism in peripheral blood lymphocytes of patients with ovarian cancer were studied. It was shown that the development of cancer pathology is associated with an imbalance in the NO synthesis in blood lymphocytes. The reason for such imbalance is the activation of arginase and inducible isoform of NO-synthase (iNOS) and significant inhibition of its constitutive isoform. The analysis of the kinetic properties of NOS of blood lymphocytes of patients with ovarian cancer was carried out. It was shown that the affinity constant of iNOS affinity for L-arginine is 5.4-fold lower than for eNOS of blood lymphocytes of persons in the control group. The inhibition of eNOS occurs via non-competitive type and is related to the reduction of maximum reaction rate.