RESULTS OF EXTRACORPOREAL NEPHRON-SPARING SURGERY FOR RENAL CELL CARCINOMA WITH AUTOTRANSPLANTATION.

The study included 12 patients who underwent extracorporeal nephron-sparing surgery followed by autotransplantation of the kidney to the iliac region. A solitary kidney occurred in 7 (58.3%) cases, bilateral tumors in 2 (16.7%) cases, a significant decrease in the function of the contralateral kidney in 2 (16.7%) cases, and relative imperative indications in 1 (8.3%) patient. The ECOG status 0, 1 and 2, respectively, was recorded in 3 (25%), 6 (50%) and 3 (25%) cases. The glomerular filtration rate in patients (GFR) averaged 51.5±16.8 ml/min, the blood creatinine level was 157.9±58.2 µmol/L, and the body mass index (BMI) was 27.7±4.9 kg/m2. The average size of tumors in the entire group reached 5.6±1.8 cm (3 to 9 cm). T1 stage was registered in 6 cases, T3a was diagnosed in another 6 cases. Besides, invasion into the renal vein was detected in 4 patients, into the pararenal or renal sinus fat in another 4 patients, into the pelvicalyceal system lumen in yet another 4 patients. Intrarenal tumors were found in 11 (91.7%) patients. Different types of vascular reconstruction were required in 4 (30%) out of 12 patients. The average time of surgical interventions reached 270.8±25.0 minutes. The average cold ischemia time during extracorporeal partial nephrectomy was 47.8±7.8 minutes. The average overall time frame of vascular anastomosis was 56.4±6.4 minutes. The volume of blood loss varied from 400 to 700 ml (on average 558.3±99.6 ml). Postoperative complications Grade III-IV by Clavien-Dindo classification were recorded in 5 (41.7%) patients. Oligoanuria in the postoperative period occurred in 4 (33.3%) patients, but hemodialysis was necessary only in two of them. Postoperative mortality was observed in two (16.7%) cases. The graft loss rate was 16.7% (bleeding and chronic urinary fistula). Long-term results were evaluated in all 10 patients. Currently none of the patients requires chronic hemodialysis. The average creatinine level after surgery in the entire group was 139.3±46.1 µmol/L (from 102.4 to 260 µmol/L). Δ serum creatinine varied from 4.0 to 60.0 µmol/L (on average 25.3±17.6 µmol/L). Δ GFR on average did not exceed -9.3±8.6 ml/min. With an average follow-up period of 42 months, no locoregional RCC recurrences were detected in any of the cases. Metachronous metastases to the lungs were found in one patient 2 years after surgery. Extracorporeal removal of a kidney tumor with renal autotransplantation is an effective method of nephron-sparing surgery in patients with imperative indications for kidney preservation. However, this technique is accompanied by a high rate of complications Grade ≥ III-IV by Clavien-Dindo system, which must be taken into account while defining the indications for its use.

URETEROCALICOSTOMY FOR RECONSTRUCTION OF THE UPPER URINARY TRACT.

The paper provides a retrospective study of long-term results of ureterocalicostomy (UC) performed in one specialized center. The study included 37 patients who underwent UC as a primary (43.2%) or secondary (56.8%) operation for intrarenal hydronephrosis or urolithiasis. All surgical interventions were classified into two groups according to the type of kidney resection: Type I - if the kidney parenchyma was more than 10 mm, the entire lower pole of the kidney was removed (72.9%); Type II - if the parenchyma was less than 10 mm, a part of the lower pole (1.5-2.0 cm) was removed in the zone of maximal parenchymal thinning (24.3%). All resections, depending on the angle of their plane, were also divided into transverse (48.6%) and oblique (51.4%). Early postoperative complications were observed in 14 (37.8%) patients. All complications were not severe and were classified as Grade I-II according to the Clavien-Dindo system. The univariate analysis showed that the predictors of UC complications are the long duration of the operation, warm renal ischemia for more than 20 minutes, the secondary nature of the operation, as well as the presence of acute pyelonephritis and urinary extravasation before the operation. The rate of good long-term results was 81.1% (n=30), satisfactory - 13.5% (n=5), poor - 5.4% (n=2). The reliable prognostic value in terms of negative surgery results had: the thickness of the renal parenchyma below 10 mm, as well as the use of Type II resection of the renal parenchyma. Conclusion. A high level of good UC results was demonstrated. The most important predictor was the renal parenchyma thickness less than 10 mm.

RECONSTRUCTION OF THE UPPER THIRD OF THE URETER WITH A TUBULARIZED PELVIS FLAP IN DIFFICULT CLINICAL SITUATIONS.

Ureteroplasty with a tubularized pelvis flap is a very rare option for urethral reconstruction. This surgical approach allows replacing extended defects of the upper third of the ureter, and in some cases the entire ureter. Pelvic tubuloplasty can also be used to correct hydronephrosis associated with additional vessels to the lower pole of the kidney. Nowadays there are only a few reports on using tubular pyeloplasty in literary sources. Not all indications for this type of reconstruction have been studied yet. Thus, not all possible methods for the pelvis flaps formation have been developed. This article presents the experience of using this surgical technique in two patients with complex clinical situations. Our experience shows that displacement the anastomosis below the lower polar arteries or veins by using tubular pyeloplasty can exclude the pathological effect of these vessels on it. Therefore, this reconstruction can be considered a standard technique for the surgical treatment of hydronephrosis caused by uretero-vasal conflict. However, this requires practical confirmation, because there is no experience of using such surgical tactics presented in the world literature now. The second clinical observation showed the possibility of reconstruction of an extended defect in the upper and middle third of the ureter by the tubular flap of the pelvis. The proposed technique for the formation of the flap allowed extending it by 2 cm and successfully performing an anastomosis between the flap and the ureter. The main advantage of this approach is the possibility of extending the flap not by reducing the width of its base, but by means of small transverse incisions at various points. This let us to save the blood supply to the flap.

Novel approach to synthesis of silver nanoparticles in interpolyelectrolyte complexes based on pectin, chitosan, starch and their derivatives.

The effect of the chemical structure of interpolyelectrolyte complexes (IPEC) based on polymers of natural origin (pectin--chitosan+, pectin--cationic starch (starch+), carboxymethylcellulose (CMC-)-cationic ß-cyclodextrin (ß-CD+), anionic starch (starch-)-cationic starch (starch+) on the structure, morphology, thermomechanical and antimicrobial properties of silver-containing nanocomposites obtained by thermochemical reduction of Ag+ ions in interpolyelectrolyte-metal complexes (IMC) was studied. Thermochemical reduction of Ag+ ions in the IMC bulk for 30 min at 150 °C led to formation of silver-containing nanocomposites and this fact was confirmed by wide-angle X-ray scattering method. Transmission electron microscopy showed that different sized of silver nanoparticles were formed depending on the chemical structure of IPEC. The average size of silver nanoparticles was found to be 4.7 nm for pectin--Ag-chitosan+; 5.3 nm for pectin--Ag-starch+; 6.3 for CMC--Ag-ß-CD+ and 9 nm for starch--Ag-starch+, correspondingly. The nanocomposites having smaller average nanoparticle size exhibited higher antimicrobial activity against S. aureus and E. coli strains. Pectin--Ag-chitosan+ nanocomposites formed by thermochemical reduction of Ag+ ions showed that the diameter of the inhibition zone against S. aureus and E. coli strains was 19.7 and 32.6 mm, respectively, whereas these values were 15.6 and 14 mm, respectively, for the same nanocomposites obtained by chemical reduction using ascorbic acid.

Forensic Engineering of Advanced Polymeric Materials-Part VII: Degradation of Biopolymer Welded Joints.

Welding technology may be considered as a promising processing method for the formation of packaging products from biopolymers. However, the welding processes used can change the properties of the polymer materials, especially in the region of the weld. In this contribution, the impact of the welding process on the structure and properties of biopolymer welds and their ability to undergo hydrolytic degradation will be discussed. Samples for the study were made from polylactide (PLA) and poly(3-hydroxyalkanoate) (PHA) biopolymers which were welded using two methods: ultrasonic and heated tool welding. Differential scanning calorimetry (DSC) analysis showed slight changes in the thermal properties of the samples resulting from the processing and welding method used. The results of hydrolytic degradation indicated that welds of selected biopolymers started to degrade faster than unwelded parts of the samples. The structure of degradation products at the molecular level was confirmed using mass spectrometry. It was found that hydrolysis of the PLA and PHA welds occurs via the random ester bond cleavage and leads to the formation of PLA and PHA oligomers terminated by hydroxyl and carboxyl end groups, similarly to as previously observed for unwelded PLA and PHA-based materials.

Effect of the type of reducing agents of silver ions in interpolyelectrolyte-metal complexes on the structure, morphology and properties of silver-containing nanocomposites.

The objective of this work is to study the peculiarities of structural organization, morphology, thermomechanical, electrical and antimicrobial properties of nanocomposites based on pectin-polyethyleneimine interpolyelectrolyte complexes and silver nanoparticles in dependence on the type of reducing agent being applied for chemical reduction of silver ions in the interpolyelectrolyte-metal complexes. The average size of Ag nanoparticles is shown to be increased with decreasing of the activity of reducing agent (E0) and equals to 3.8 nm, 4.3 nm, and 15.8 nm, respectively, when engaging sodium borohydride (-1.24 V), hydrazine (-1.15 V) and ascorbic acid (-0.35 V). Moreover, it was found that the crystallite size of Ag nanoparticles also had the smallest value for nanocomposites obtained involving NaBH4 as reducing agent. Ag-containing nanocomposites prepared by reduction of silver ions in interpolyelectrolyte-metal complexes while applying a range of reducing agents are characterized by different electrical properties and polymer matrix' glass transition temperature. The influence of silver nanoparticles' size incorporated in the polymer matrix on the antimicrobial activity of nanocomposites has been established. The inhibition zone diameter of Staphylococcus aureus and Escherichia coli was higher for nanocomposites obtained using sodium borohydride and hydrazine compared to nanocomposites where ascorbic acid was used as the reducing agent.

Constant Electric and Magnetic Fields Effect on the Structuring and Thermomechanical and Thermophysical Properties of Nanocomposites Formed from Pectin-Cu(2+)-Polyethyleneimine Interpolyelectrolyte-Metal Complexes.

Applying wide-angle X-ray scattering method, thermomechanical analysis, and differential scanning calorimetry, the structural organization and properties of nanocomposites formed by chemical reduction of Сu(2+) cations in the interpolyelectrolyte-metal complex (pectin-Cu(2+)-polyethyleneimine) under the influence of a constant magnetic and electric fields have been studied. It has been found that the chemical reduction of Cu(2+) cations in the interpolyelectrolyte-metal complex bulk under constant electric and magnetic fields leads to formation of nanocomposite consisting of interpolyelectrolyte complex, including pectin-polyethyleneimine and nanoparticles of the metal Cu phase, whereas nanocomposite with Cu/Cu2O nanoparticles is formed in original state (without any field). It was observed that, under constant field, nanocomposites obtained have higher structural glass-transition temperatures and thermal stability.

[CREATING A CROSS-TUNNEL UNDER OSTIUM OF MAIN HEPATIC VEINS AND PIGGY BACK FUND LIVER ABLATE TUMOR THROMBUS FROM THE INFERIOR VENA CAVA].

The analysis of the effectiveness of a new method of thrombectomy, including the formation of cross-tunnel under the ostium of the main hepatic veins by removing tumor thrombus of the inferior vena cava (IVC). Successfully perform a piggy back manage to mobilize the liver in 12 (80%) patients, a tunnel formed in 4 (50%). Duration pigg back stage liver mobilization much higher than the formation of the tunnel. Forming tunnel cross recommended conditions when the IVC portion covered retrohepatic liver less than 1/2 of a circle or when the surgeon is sure to Derform manipulation capabilities.

[ROLE OF FACTORS OF THE ENVIRONMENT OF EDUCATION AND TRAINING IN THE FORMATION OF THE DYSPLASIA OF THE CONNECTIVE TISSUE IN TEENAGE YEARS].

Negative trends of indices of the incidence in children and teenagers in the Russian Federation are caused by essential changes in the system of training and medical care of school students. In cases of connective tissue dysplasia (CTD) when the gene defect is remains to be unascertained, there is a great role of environmental factors contributing to the implementation of pathology and hygienic measures of the prevention of complications. There was performed the hygienic assessment of sanitary-epidemiologic welfare (SEW) of the educational institutions (EI) of the city of Omsk (n = 76), including the study of environmental factors, health and performance of adolescents. For the correction priority factors for SEW were "medical care", "mode and organization of the educational-training process", "conditions and organization of nutrition", "conditions and organization of physical education." There are determined the most important for the occurrence of CTD indices lifestyle factors and "indicators" of the risk for the progression of pathological processes in adolescents.

[The working conditions at animal farm complexes of workers with occupational brucellosis].

According to sanitary-and-hygienic characteristics of working conditions, cards certification of working conditions at workplaces, cards of epizootologo-epidemiological inspection of the zoonotic disease' centres and medical records of outpatient working conditions of 134 workers of cattle-breeding complexes of Omsk region, professional brucellosis' patients are studied. Harmful factors of working conditions' workers of cattle-breeding complexes are the biological factor, weight and intensity of labour process (a 3.2-3.3 class), factors increasing risk of occurrence professional brucellosis were absence of preliminary at receipt for work and/or irregularity periodic physical examinations, infringements of sanitary-and-epidemiologic mode, lack of awareness of workers about the possibility of brucellosis' contamination in the workplace.

[Sociohygienic monitoring of the working conditions of workers at an aircraft engine factory].

The authors have improved, modified, and introduced a sociohygienic monitoring model proposed by Yu. V. Erofeyev, V. V. Dalmatov, and D. V. Turchaninov (2007) in the P. I. Baranov engine association and proposed objective criteria for evaluating the work space.

[Efficiency of complex rehabilitation in chronic obstructive pulmonary disease and occupational bronchitis].

AIM: To evaluate the efficiency of the rehabilitation in patients with obstructive pulmonary disease (COPD) and occupational bronchitis (OB) and the disabled due to these diseases, which was based on the authors' developed procedure and criteria for evaluating the efficiency of rehabilitative measures. MATERIALS AND METHODS: The efficiency of implementation of 55 individual rehabilitation programs (RP) elaborated by the Medicosocial Examination Bureau for the disabled due to COPD and OB was evaluated. RESULTS: The authors have determined qualitative criteria for evaluating the efficiency of rehabilitation: the extent to which the recommended rehabilitation measures being implemented, the trend in the magnitude of various vital activity categories and social inadequacy and in the disability group on regular examination, the results of implementation of some parts of an individual RP, the conformity of the achieved results to the rehabilitation potential of a disabled patient. The evaluation procedure supposes a unified quantitative gradation of each criterion. Overall, rehabilitation is more effective in COPD than in OB. CONCLUSION: The developed criteria and procedures for evaluating the efficiency of rehabilitation in patients with COPD and OB show a great informative value and practical content richness, which permits one to make corrections into the rehabilitation process. Functional impairments, the degree of vital activity restrictions and social inadequacy, as well as the rehabilitation potential and rehabilitation prognosis are concomitantly evaluated, which allows minor changes to be assessed in the clinical, personality, and social status of a patient.

[Clinical aspects of rehabilitation potential in patients with chronic obstructive pulmonary disease].

AIM: To reveal and evaluate clinical signs influencing rehabilitation potential in COPD patients. MATERIAL AND METHODS: Clinical findings in COPD patients were analysed at medical and social expert examination (MSEE). RESULTS: Progression of the pathological process is associated with aggravation of chest pain, fever, sputum discharge at coughing. Cough and dyspnea occurred in all the examinees irrespective of the disease etiology. Severity of respiratory failure correlated with severity of COPD. Respiratory and circulatory failure aggravate quality of life. The study determined clinical signs in patients with COPD of various etiology which influence rehabilitation potential of COPD patients. This helped specification of disability criteria and certification. Conclusion. In MSEE of COPD patients it is necessary to base on the patient's complaints, duration of the disease, severity of functional respiratory and circulation failure, complications, social problems.

[Leukinferon-induced changes in cytochemical parameters of the wound exudate neutrophilic granulocyte nucleus and cytoplasm in patients with maxillofacial phlegmons]. / Leikinferonindutsirovannaia dinamika tsitokhimicheskikh pokazatelei iadra i tsitoplasmy neitrofil'nykh granulotsitov ranevogo ékssudata u bol'nykh s flegmonami cheliustno-litsevoi oblasti.

Clinical and cytochemical study of the wound exudate neutrophilic granulocytes (NG) in patients with maxillofacial phlegmons treated traditionally and with leukinferon (immunomodulator) added to basic therapy demonstrated a positive clinical effect and pronounced stimulation of NG in the patients treated with leukinferon. The time course of cytochemical parameters of NG cytoplasm and chromatin activity was principally different in the two groups of patients. A new tissue index of NG was developed, giving an accurate integral picture of the total biological activity of the wound exudate NG.

[Prevalence, diagnostics, and therapy of psychotic disorders among general somatic diseases]. / Rasprostranennost', diagnostika i lechenie psikhicheskikh rasstroistv v obshchesomaticheskoi seti.

The paper presents observational data of depression extent among general patients. Psychosomatic disorders are considered in the article. The authors analyzed the mental disorders incidence among different groups of somatic patients, a problem of using the various treatment techniques in these groups. Authors propose the treatment of depression observed among general patients; it is based on literature data and their own observations.

[Work with youth--the basis of educational programs aimed at the prevention of HIV infection]. / Rabota s molodezh'iu--osnova obrazovatel'nykh programm, napravlennykh na profilaktiku VICh-infektsii.

During the recent 10 years, 1987-1997, syphilis morbidity was found to increase 60-fold in Omsk Province. In 1997 adolescents constituted 6.0% in the structure of persons who contacted the disease. In this year more than 500 adolescent using drugs were registered in the region. The introduction of drugs by injection was practiced by 9.6% of the adolescents. The program aimed mainly at changing the behavior of young people with orientation on the choice of a healthy mode of life and theirs information about risk factors associated with sex transmitted diseases particularly HIV infection is discussed.

[The function of the reproductive system in x-ray-irradiated male rats after the transplantation of a culture of testicular cells from newborn piglets]. / Stan reproduktyvnoï systemy u renthenoprominenykh samtsiv shchuriv pislia transplantatsiï kul'tury klityn sim'ianykiv novonarodzhenykh porosiat.

The effect exerted by transplantation of the 5 day culture of testicles from newly born piglets on the hypogonadal state of mature X-ray irradiated (3 Gy) rats was studied. It has been found that a month after transplantation (two months after irradiation) the hypogonadal state disappeared for a while, which is confirmed by normalization of the weight of seminal vesicles, content of testosterone and biologically active lutropine, restoration of the reproductive function of rats. No significant changes in steroidogenesis activity have been found, which proves a substituent character of transplantation. The effect disappears three months later but certain restoration of the content of nucleic acids in the testicles is observed.

[Effect of 131I incorporation on the status of the reproductive system in male rats and the dose-dependent effect]. / Vliianie inkorporatsii 131I na sostoianie reproduktivnoi sistemy samtsov krys dozozavisimogo éffekta.

Radioactive 131I was injected in single doses 9.25, 37, and 92.5 kBq to prepubertal (30-day-old) male rats. Iodine incorporation in doses 37 and 92.5 kBq resulted in some functional changes in the reproductive system of mature rats: blood testosterone level increased, its hypothalamic aromatization intensified, and biologically active LH level in the blood dropped. Incorporation of 9.25 kBq of 131I had no effect on male reproductive system. A possibility of direct injury to rat testicles by 131I incorporation is suggested.

[The reproductive function of male rats in the late periods after x-ray irradiation]. / Reproduktivnaia funktsiia samtsov krys v otdalennye sroki posle rentgenovskogo oblucheniia.

Reproductive function in male rats was studied in 1, 3 and 6 months after X-ray irradiation of doses of 2 and 3 Gy. It has been established that long-term effects of irradiation at a dose of 3 Gy are manifested through decrease in spermatozoa content in the epididymis and reduction of nucleic acid and protein content in the testes. Fertility of male rats under study significantly lowered shortly after irradiation and full recovery of fecundating ability was observed 6 months later. The effect of irradiation with a dose of 2 Gy was less pronounced.