[Health assessment of newborns with congenital urinary malformation].

Improvement in diagnosis of prenatal congenital urinary malformations (CUM) resulted in increased detection of CUM cases among newborns. To facilitate medical care for CUM newborns, we have developed an objective method of CUM newborns' health assessment. We studied 40 case histories of newborns with prenatally detected CUM admitted to urological clinics (20 with diagnosis of poor health and 20 with moderate condition severity) and 40 CUM newborns examined outpatiently (moderate health hazard). The computer analysis of the available data has established 13 most informative diagnostic criteria: 4 sonographic criteria, 3 lab criteria and 6 physical exam criteria estimated by 4 points - from 0 to 4. The criteria were pooled to a table which was used as a scale to assess general health condition. After delivery, CUM newborn gets inpatient health assessment by a neonatologist using 13 criteria. According to the total score, the condition is assessed as satisfactory (0-5), moderately severe (6-11), severe ( > 12). Efficacy of such health assessment was proved in a population study of 312 prenatal CUM newborns. Grouping of such newborns helps design of programs of further examination and management.

[Optimization of diagnostic and therapeutic tactics for primary megaureter in children].

Obstructive megaureter (MU) and refluxing MU were treated in 2000-2004 in 580 and 711 children, respectively. This number was by 18.9% higher than in 1990-1994. Out of 1291 children with MU, two groups of patients were singled out: group 1 with primary obstructive MU (n = 158) and group 2 with primary refluxing MU (n = 185). In patients of groups 1 and 2 the following operations were made: ureteral reimplantation (n = 126), Koen's operation (n = 104), Politano-Leadbetter operation (n = 12), Lich-Greguaru operation (n = 8), nephrureterectomy (n = 32), heminephrureterectomy (n = 27), transurethral dissection of ureterocele (n = 8), other in 26 patients. A great number of primary nephrureterectomies evidence for frequent morphofunctional immaturity of one of the kidneys in children with primary MU forms. The 1.5-6 year follow-up results were good in 85.4% children of group 1 and 94.1% children of group 2. In planning follow-up and assessing long-term follow-up results morphofunctional state of the kidney and ureter before and after operation must be considered according to the following main criteria: dilation of the caliceal-pelvic system and ureter, renal function, pyelonephritis activity, the presence or absence of recurrent stricture of the distal ureteric segment or the presence of vesicoureteral reflux.

[Diagnosis and treatment of locally advanced cancer of the urinary bladder]. / Diagnostika i lechenie mestno-rasprostranënnykh form raka mochevogo puzyria.

The term "locally advanced cancer of the urinary bladder" is discussed. The data on examination and treatment of 375 patients are presented to work out criteria of diagnosis of the disease. Such patients have been shown to reveal extensive lesions from bladder tumor coupled with such homeostatic disorders as hypoamino-acidemia, endotoxicosis, metabolic acidosis, immunity deficiency and disturbed hemoglobin-mediated transport of oxygen. Early postoperative complication incidence can be cut by 30-47% and 3-year survival after cystectomy-increased by 19% provided said homeostatic disturbances are corrected and immuno- and biostimulation is carried out. The best results in the treatment of locally advanced urinary bladder cancer (T2(m)N0M0) were recorded among cases of organ-saving therapy-65-70% have survived 5 years. Only 36.4% of patients with tumor (T3abN0M0) who received complex treatment (cystectomy + preoperative homeostatic correction) have survived 5 years. None of the patients with tumor (T4N0M0) has survived 3 years; therefore, only radiation and chemotherapy should be recommended in such cases.

[The dispensary care and work disability expertise of bladder cancer patients following cystectomy]. / Dispanserizatsiia i vrachebno-trudovaia ékspertiza bol'nykh rakom mochevogo puzyria posle tsitéktomii.

A question of the principles and methods of medical prophylactic survey in patients with bladder cancer who have undergone cystectomy with subsequent ureterosigmoid anastomosis and ureterocutaneostomy is not currently developed. On a basis of 79 follow-ups of patients with bladder cancer after cystectomy, a procedure of prophylactic survey in the setting of regional oncologic dispensary and district polyclinic was worked out. It is stressed that it is necessary to follow up the patients for a possible relapse and metastasis development as well as complications of the upper urinary tract and kidneys and metabolic shifts (acidosis, dyselectrolytemia). From this viewpoint we propose a scope of essential examinations during the medical prophylactic survey. Our results of the patients follow-ups after cystectomy are also given. Recommendations for the patients working ability estimation are proposed and it is noted that the estimation is to be carried out on a strictly individual basis because the patient's rehabilitation depends on many factors. But the main principles of such patients' working ability estimation are submitted in schemes of a working ability examination. They depend on the stage of the process and on the method of urine drainage after cystectomy.

[The content of the carcinoembryonic antigen in the blood serum of patients with bladder tumors at various stages of combined treatment in relation to the disease stage]. / Soderzhanie rakovo-émbrional'nogo antigena v syvorotke krovi bol'nykh s opukholiami mochevogo puzyria na razlichnykh étapakh kombinirovannogo lechenia v zavisimosti ot stadii zabolevaniia.

Serum level of a tumor marker, carcinoembryonic antigen (CEA), was examined in patients at different stages of vesical cancer before and during combined treatment, including preoperative large-fraction radiotherapy and surgery. Sixty patients with histologically documented vesical cancer, stages T1N0M0, T2N0M0, T3N0-1M0 and T4N0M0 were investigated. All patients underwent large-fraction radiotherapy prior to surgery. Transvesical resection of the bladder wall with the tumor or cystectomy was performed within 24-72 hrs after radiation exposure. Serum CEA was measured repeatedly (on admission, after preoperative radiotherapy, postoperatively, at discharge) by enzyme immunoassays. It is demonstrated that CEA variation in the course of combined treatment depends on the stage of cancer. CEA level decreased after preoperative large-fraction radiotherapy in patients with T1, T3 and T4 stages of cancer, and increased in patients at the T2 stage. Following combined treatment, serum CEA was reduced two-fourfold as compared to pretreatment values in patients with first, third and fourth stages of vesical cancer, an evidence of the adequacy and radical quality of treatment and a favorable predictive sign.