[Balanoposthitis in the clinical practice of a urologist and dermatovenereologist: an interdisciplinary problem].

Balanoposthitis is a common inflammatory disease of the male genitals, which occurs more often in uncircumcised men. The cause of balanoposthitis can be an infectious, inflammatory or autoimmune process, as well as traumatization. In most cases, after proper intimate hygiene and the use of neutral moisturizers, the symptoms of balanoposthitis are completely stopped. In the case of torpid course of balanoposthitis and in the absence of improvement after drug therapy, it is necessary to exclude the malignant process. In the review article, the authors present the data of modern scientific research on the qualitative and quantitative composition of the microbiome in balanoposthitis. Differences in the composition of the microbiome were revealed in patients with balanoposthitis and healthy patients from the control group with excess foreskin. It was found that in patients with balanoposthitis, a impaired in hydration of the skin of the glans penis was revealed. Staphylococcus warneri and Prevotella bivia are the most common species associated with balanoposthitis and positively correlate with the severity of the disease. Candida infection, as an etiological factor of balanoposthitis, often occurs in children and may be associated with diaper rash. The prevalence of Gardnerella vaginalis as a pathogen in the male urogenital tract has not been fully studied. Currently, there are no reliable scientific studies that make it possible to attribute G. vaginalis to the etiological factor of balanoposthitis in men. However, it should be borne in mind that balanoposthitis may have a polymicrobial and synergistic etiology with the participation of G. vaginalis and anaerobic bacteria in the lower genital tract of men. The review article is clearly illustrated with clinical examples of the disease from the personal practice of the authors.

[Urological problems related to coloproctology. Part 2].

The second part of the review article is devoted to current urological and proctological issues: rectal injuries during urological procedures, rectal complications associated with prostate cancer, as well as violations of the genitourinary function during interventions on the pelvic and rectal organs. Ignoring the symptoms from the adjacent pelvic organs can lead to diagnostic errors and the choice of wrong treatment, which ultimately adversely affects the outcomes. The interaction of specialists "working in the small pelvis" is required to exchange experience and improve the quality of care for this category of patients.

[Urological problems related to coloproctology. Part 1].

The aim of this review was to characterize the possible urological manifestations of rectal disorders in case of the involvement of the genitourinary system, as well as the symptoms of urological diseases involving the distal part of the large bowel. In urological and coloproctological practice, the anatomical and physiological proximity of the distal part of the intestine and the urogenital organs is of importance (for example, the common innervation of the pelvic organs, the synergy of the pelvic floor muscles, etc.), since it results in similar clinical manifestations, making it difficult to make a diagnosis. The most relevant and common urological and proctological diseases, including prostatitis, intestinovesical and rectourethral fistulas, damage to the ureter and bladder during colorectal surgery are discussed in the article. Particular attention is paid to the interdisciplinary cooperation of urologists and proctologists and the frequent need for their joint participation in the diagnosis and treatment of the pelvic organs disorders.

[Evaluation of the influence of systemic enzyme therapy on immune reactions in genitourinary chlamydia infection].

PURPOSE: Assessment of the severity of immunological disorders in patients with hlamydia trachomatis (CT) infection and the effectiveness of antibacterial therapy in combination with systemic enzyme therapy for the eradication of pathogenic pathogen and correction of detected violations of the immune system. MATERIALS AND METHODS: 84 patients with identified CT infection were divided into 2 clinical groups: group 1 (42 people) received antibiotic therapy with doxycycline monohydrate for 10 days, 100 mg 2 times a day (the first dose of 200 mg) at regular intervals (daily dose of 200 mg, course - 2.0 g.) in combination with phlogenzyme, 3 tablets 2 times a day within 14 days. The second clinical group (42 people) received only doxycycline monohydrate therapy at the same doses as in the first clinical group. In all patients with CT infection (84 people) and in the control group (32 practically healthy people), the activity of immune reac-tions in the body was additionally assessed by the level of cytokines (-INF, IL-1, IL-4, IL-6), circulating immune complexes (CIC), lactoferrin (LF) and 2-macroglobulin in blood serum. RESULTS: The level of CEC in the blood serum of patients with CT infection is significantly higher than the standard indicators (by 1.83 times) compared with the indicators of the control group (106.1+/-5.12 conventional units versus 57.8+/-3.39 conventional units, p<0.05). The level of -IFN in the blood serum of patients with CT infection is 1.64 times lower than in the control (28.9+/-4.15 pkg / ml and 47.3+/-4.26 pkg / ml, p<0.05), and indicators of IL-1 in blood serum - 3.12 times higher; the level of IL-6 is 2.13 times higher (p<0.001); the level of IL-4 is 1.65 times higher (p<0.05). The Lf level in patients with CT infection exceeded 2.37 times the indicator in the control group (1742.0+/-112.15 ng / ml and 732.1+/-36.11 ng / ml, p<0.001), 2-macroglobulin - in 1, 36 times (2.59 - 0.21 mg/l and 1.9 - 0.47 mg / l, p<0.001). The efficiency of clinical and microbiological cure in patients with CT infection, who received complex therapy with doxycycline monohydrate and phlogenzyme, was 97.6%. With monotherapy (doxycycline monohydrate), the effectiveness of clinical and microbiological cure was significantly lower - 78.6%, statistically significant (OR=11.2; 95% CI 1.3-247.9; p=0.007). The fact of a decrease in the activity of Th-2 type of the cellular link of immunity in patients with CT infection receiving systemic enzyme therapy drug was established. DISCUSSION: One of the pathogenetic mechanisms of CT infection is an imbalance in the cytokine profile, which manifests itself in an increase in the level of cytokines of the Th-2 (IL-6) type and a decrease in the Th-1 (-IFN) type. With the predominant production of pro-inflammatory cytokines (IL-1, IL-6), the dynamics of CT infection becomes chronic. A decrease in the reserve capacity of the proteolytic enzyme system during CT infection with a subsequent increase in the level of 2-macroglobulins in the blood contributes to the dysregulation of local inflammation processes and the formation of immune disorders. With a long course of CT infection, it is most advisable to use (as a basic pathogenetic therapy) systemic enzyme therapy (phlogenzyme). The effect of systemic enzyme therapy on immune responses in C. trachomatis enhances the activity of the Th-1 type of cytokines (-IFN) and a decrease in the level of 2-macroglobulins and pro-inflammatory cytokines (IL-1, IL-6) in the blood. Systemic enzyme therapy can significantly increase the effectiveness of antibiotic therapy and reduce the risk of side effects. CONCLUSION: The theoretical argumentation of the pathophysiological mechanisms of disorders in the interaction of the most important functional systems made it possible to substantiate new conceptual approaches to the therapy of CT infection, taking into account the level and specific disorders in the universal systems of homeostasis regulation. In particular, a pathophysiological basis has been provided to substantiate the advisability of combining antibacterial therapy with systemic enzyme therapy drugs to correct systemic immunological disorders in patients with CT infection.

[The role of mycoplasma infection (M. hominis and U. urealyticum) in inflammatory diseases of the genitourinary system the debate continues].

The article presents current views on urogenital diseases caused by M. hominis and U. urealyticum. Particular attention is paid to concurrent (co-occurring) urogenital infections. The review reports the data from epidemiological studies and outlines recent Russian and international guidelines and consensuses on managing patients with urogenital inflammatory diseases. The importance of adequate diagnosis and rational therapy of urogenital infections is discussed.

Interferon-Gamma: Treatment Horizons.

The review provides modern literature data on the system of interferons, their cells producers and target cells. Particular attention is paid to the immunomodulating effect of interferon-y. High efficacy of Ingaron in the treatment of various groups of diseases, especially viral, infectious and oncologic is shown.

DIAGNOSTIC SIGNIFICANCE OF SKIN "SIGNS" IN CHRONIC DIFFUSE LIVER DISFASES.

AIM: Frequency Estimation of registration of various skin changes in patients with chronic diffuse liver diseases (CDDL). SUBJECTS AND METHODS: A cross-sectional observational study in patients with CDDL and dermatological changes. The basis of this study - the results of clinical and laboratory findings 468 patients with various liver diseases (viral, toxic, parasitic). RESULTS: A detailed analysis of dermatological manifestations of"dermal signs" in the studied group has allowed both to expand their roster, and refine clinical description of some of them. Specifically, that patients can simultaneously generate multiple dermatological stigmata. CONCLUSION: The results suggest that skin extrahepatic "marks" is very variable. Their various combinations available to patients is a high screening signs of liver disease. The data can be used by physicians gastroenterologists and dermatologists.

[25-year trends of incidence and mortality from liver cancer and viral hepatitis in Novosibirsk].

The article presents data of Cancer Registry in Novosibirsk for the period 1988-2012 concerning primary liver cancer. Over the period studied the incidence and mortality have declined significantly (2,5 and 2,1 times, respectively). Both figures fall in line for men and women being generally twice as high in men. The long-term trends of main etiologic risk factor for liver cancer (prevalence of hepatitis viruses B and C in the population) are shown. The issues of screening and prevention are discussed.

[Combination therapy of chronic bacterial prostatitis].

The article discusses the possible etiological factors in the development of chronic bacterial prostatitis. The authors presented a comparative long-term analysis of morbidity from non-viral sexually transmitted infections (STIs) in Russia. Against the background of general decline in STIs incidence, a significant percentage of them is made up by urogenital trichomoniasis. The findings substantiated the advantages of combination therapy (ornidazole and ofloxacin) for bacterial urinary tract infections.

[Toxoplasmosis: Epidemiology, Diagnosis, Treatment].

The up-to-date literature and original data on the epidemiology, diagnosis and treatment of toxoplasmosis are presented. Particular attention is paid to the parasite infection during pregnancy. Spiramycin is the drug of choice for acute toxoplasmosis in pregnant women.