[The relationship between penile hemodynamic parameters in cavernous rteries and penile rigidity].

INTRODUCTION: Blood flow parameters in cavernous arteries during full-erection phase on Doppler ultrasonography are associated with intracavernosal pressure and, consequently, with penile rigidity. AIM: To examine the relationship between blood flow parameters in cavernous arteries and the penile rigidity. MATERIALS AND METHODS: A total of 54 healthy men and patients with erectile dysfunction of various degrees of severity, with mean age of 43,0 +/- 2,2 years ranging from 18 to 74 years, were included in the study. Erectile function was examined and 81 Doppler ultrasonography were performed after intracavernosal injection of alprostadil (10 mcg). In full-erection phase, peak systolic velocity (PSV) and systolic acceleration (SA) were measured, as well as resistive index (RI). Mean values were calculated for both cavernous arteries. Penile rigidity was assessed in three ways: clinical evaluation according to I. Goldstein, measurement of surface rigidity and evaluation of longitudinal rigidity. RESULTS: During Doppler ultrasonography a strong correlation of penile rigidity with RI (0,71-0,85) and SA (0,63-0,69) was found. Indirect assessment of penile rigidity using PSV values was less precise. With RI values close to 1,0, SA is a more reliable method for indirect rigidity assessment. CONCLUSION: Penile blood flow parameters, RI and SA, allow to evaluate a degree of rigidity and to eliminate subjectivity of the specialist performing the examination, as well as to obtain a range of penile rigidity values.

[Focal laser coagulation in the treatment of a patient with kidney cancer and prostate cancer].

The article describes the clinical observation of the patient 84 years old with prostate cancer T2bNxM0, left kidney cancer T1N0M0 and severe comorbidity. Stepwise interstitial laser coagulation was performed using the Russian microsecond Nd: YAG laser surgical complex.

[Interstitial laser coagulation in the management of urothelial papillary carcinoma of the renal pelvis].

This article presents a case of a 59-year-old patient with a primary tumor of the right kidney with bladder and liver metastases. The patient was treated in three-stages. In the first stage, he underwent ureteral stone extraction, laser resection of the tumor with subsequent vaporization. In the second stage, a repeat laser resection and vaporization of the tumor was performed. During the third stage, the patient underwent TUR of the bladder wall with the tumor, followed by laser vaporization of the tumor bed. During a 9-year follow-up, no signs of tumor growth or metastasis were observed.

[Age-related androgen deficiency. The current state of the problem].

This paper reviews the modern concept of age-related androgen deficiency. The authors discuss the prevalence of androgen deficiency and its relationship with age, concomitant diseases, pharmacotherapy and other factors.

[Large urethral stones: a case report].

The article describes a clinical observation of a 68 y/o patient with large stones of the urethra, reaching 5 cm in length and located in the penile urethra. The patient underwent a three-stage treatment: the first stage consisted of drainage of the urinary bladder, the second stage of the urethrolithotomy and a double-barreled fistula, the third was an anastomotic urethroplasty. After removing the cystostomic drainage tube, normal urination was restored.

[The development of strategic management of high-tech surgical medical care].

The high-tech surgical medical care is one of the most effective types of medical care in Russia. However high-tech surgical treatment very often is inaccessible for patients. The development of basics of strategic management of high-tech surgical care makes it possible to enhance availability of this type of care and to shorten the gap between volumes of rendered care and population needs. This approach can be resulted in decrease of disability and mortality of the most prevalent diseases of cardio-vascular diseases, malignant neoplasms, etc. The prerequisites can be developed to enhance life quality and increase longevity of population.

[Correction of complement system failure in patients with chronic prostatitis].

The aim of the study was detection of local and systemic changes in the complement system in patients with chronic abacterial prostatitis (CAP) and chronic bacterial prostatitis (CBP) and to assess a relevant corrective efficacy of the hardware and software complex Andro-Gin (KAP-ELM-01 Andro-Gin). Before treatment, blood plasma of CAP patients contained elevated concentrations of all studied components of the compliment system and factor H but subnormal concentration of C1-inhibitor. Locally, all the compliment indices were high including C1-inhibitor and factor H except component C5. Initial blood plasma compliment fractions in CBP patients were elevated but regulatory proteins concentrations were low. Local compliment components C3, C4, C5 and C5a and factor H were significantly higher. Standard treatment of CAP partially corrected the level of C3, C3a, C4 components, locally normalized concentration of C3 component and corrected C4 component, while in CBP standard treatment normalized concentration of C3 component and reduced C3a, C4, C5 and C5a components, locally normalized the levels of C3, C4 components, corrected concentration of C3a, C5, C5a components, raised regulatory factors. Combination of the standard treatment with Andro-Gin unit compared to standard treatment alone, in CAP corrected plasma concentrations of C3, C3a, C4 compliment components and significantly raised levels of regulatory factors, locally--partially normalized the level of factor H. In CBP additional use of Andro-Gin more significantly improved concentrations of C3a and C5a components , locally--C5a component, raised significantly concentration of regulatory factors C1-inhibitor and factor H. Thus, KAP-ELM-01 Andro-Gin administration in CAP and CBP patients promotes more effective correction of systemic and local disorders in the compliment system, the improvement being more pronounced in CBP.

[Correction of immunometabolic disorders in chronic bacterial prostatitis].

Patients with chronic bacterial prostatitis were found to have disorders in blood parameters of complement system activity, neutrophil function and metabolic status. The above disorders are resistant to adequate correction with standard treatment but can be successfully managed with combined use ofimmunomodulators (ferrovir, galavit), antioxidants (mexidol, olifen) and membranoprotectors (phosphogliv, essentiale). Thus, immunometabolic status in chronic prostatitis can be corrected with the above combined treatment.

[Correction of local immunometabolic disturbances combined with chronic prostatitis in prostatic adenoma].

We compared local immunometabolic effects of two dosage forms of longidase in patients with prostatic adenoma (PA) in combination with chronic prostatitis (CP) in the postoperative period. Transurethral resection (TUR) of the prostate was conducted in 81 patients aged 50-70 years suffering from PA and CP. All the patients after TUR were divided into three groups by postoperative treatment: group 1 (n = 25) received standard pharmacotherapy, group 2 (n = 28)--standard pharmacotherapy and longidase injections, group 3--standard pharmacotherapy plus longidase suppository. Immunological parameters were studied in biological material (urine) obtained before operation, after it and after treatment course. By changes in immunometabolic status (concentrations of cytokines TNFalpha, IL-1beta, IL-2, IL-4, IL-6, IL-8, IL-10, IL-18, receptor antagonist IL-1 Ra, complement components C3-, C3a-, C4-, C5-, C5a, regulators of the complement system factor H, C1-inhibitor) and sIgA, content of acylhydroperoxides, malonic dialdehyde, stable metabolites of hitric oxide, catalase and superoxiddismutase activity it is shown that PA patients with CP have pretreatment disturbances of local immunity and oxidant status (high levels of proinflammatory cytokines, subnormal IL-10, activated complement system, lipid peroxidation, low sIgA, NO-synthetic activity of capillary endothelial activity). TUR aggravates shifts of local immunometabolic status. Standard postoperative pharmacotherapy does not correct the disturbances adequately. The addition of longidase to standard postoperative treatment was effective in correction of immune and oxidant status. Thus, longidase injections and, especially, suppositories correct disturbances of local immunity and oxidant status in patients with PA and CP in postoperative period.

[Clinical and immunological characteristics of rubella in western Siberia].

Evaluations of immune system of 155 patients with rubella and 90 contacts with patients were examined. Detection of viral genetic material in blood, urine, and nasopharyngeal swabs has been performed using RT-PCR method. Clinical diagnosis has been confirmed by RT-PCR in 114 (73.5%) patients. Changes of laboratory tests for rubella without clinical signs of the infection were observed in 20% of contacts. Complex ELISA- and PCR-assisted examination of patients can help to determine the stage of disease and characteristics of immune response. For differential diagnostic of rubella and other infectious diseases with exanthema it is rational to perform complex examination of patients using immunologic and molecular biologic methods.

[Opportunity of operative traumatism decrease in patients with complicated tricuspid valve defect]. / Vozmozhnosti snizheniia travmatichnosti operatsii u bol'nykh s oslozhnennymi trekhklapannymi porokami serdtsa.

This study examined the results of surgical trivalve of 44 patients with trivalve heart defect. In all the patients the heart defect was combined with two and more complicating factors: advanced III-degree calcinosis of the valves, cardiomegaly, cardiac fibrillation, left atrium thrombosis, high pulmonary hypertension. In 20 patients the operative intervention on the heart was repeated. The analysis of the results allowed to recommend some surgical techniques which allowed to decrease surgical traumatism in patients with complicated trivalve heart defect. Low traumatism was possible because of incomplete removal of the calcium masses extending on the fibrotic ring and outside, use of two-row counter U-suture on linings for the prosthesis fixing, transdoubleatrial approach without isolation of the heart from the adhesions in dense pericardial obliteration, correction even insignificant trivalve heart defect or relative valve incompetence.

[The use of oxidant-antioxidant system indices in forming groups at high genetic risk]. / Ispol'zovanie pokazatelei oksidantno-antioksidantnoi sistemy pri formirovanii grupp vysokogo geneticheskogo riska.

While studying the pathogenetic mechanisms of Down syndrome, the imbalance of oxidant-antioxidant system in donors of extrachromosome 21 was detected. This fact was a basis for screening of new prenatal biochemical markers of Down syndrome. The ratio of free radical processes intensity and SOD activity was found as most informative index reflecting the state of oxidant-antioxidant system. It was proposed as additional criterion for the formation of high risk groups to increase the efficiency of prenatal diagnostics of Down syndrome.

[The biochemical marker dynamics of the maternal serum in different chromosomal disorders of the fetus]. / Dinamika biokhimicheskikh markerov materinskoi syvorotochki pri razlichnykh khromosomnykh narusheniiakh u ploda.

The reasons for false-positive results of Down syndrome screening have been analysed. It has been found that the family pericentric inversions of chromosome 9 in fetus are accompanied by AFP and HCG changes equal to Down syndrome pregnancies. The average marker's levels in cases of per inv (9) were: AFp-0.51 MoM, HCG-3.71 MoM. The dynamics of markers in amniotic fluid has been studied. Clinical significance of per inv (9) in medicogenetic consultation were discussed.