[Prognostic value of ki-67 and vimentin markers in patients with metastatic kidney cancer].

The study was aimed to determine the role of ki- 67 and vimentin markers in choosing the tactics of surgical treatment of patients with metastatic kidney cancer. The analysis of the results of treatment of 71 patients with metastatic renal cell carcinoma was performed. The first group included 16 (22.5%) patients, who underwent complete removal of distant metastases after nephrectomy. The second group consisted of 55 (77.5 %) patients who underwent cytoreductive nephrectomy only. Immunohistochemical analyses of tissues removed were performed in all patients for the evaluation of ki-67 and vimentin expression levels. When comparing the outcomes of patients after complete removal of metastases depending on the vimentin and ki-67 expression levels (< 10% and > 10%), a significant increase in the cumulative survival in the case of absence of vimentin and ki-67 expression of <10 % (log - rank test, P = 0.0001) was revealed. The same pattern was noted in the group of patients who underwent nephrectomy only. In the absence of expression of vimentin and ki-67 < 10%, survival rate in patients who underwent metastasectomy after nephrectomy was significantly higher compared with patients who underwent nephrectomy only (P = 0.001). In the case of positive expression of vimentin and ki-67 > 10%, differences in survival rate in these groups were not observed (P > 0.082). Thus, an association between the vimentin and ki-67 expression levels and the degree of spread of metastatic renal cell carcinoma was identified: the high level of expression of these markers precludes the increase of life expectancy of patients after removal of all metastases.

[Exenatide stimulated solute-free water excretion by human kidney].

Exenatide effect was studied in 55 human including 38 patients with type 2 diabetes mellitus without signs of diabetic nephropathy and primary renal diseases. Preliminary study with water load in volume from 0.5 to 1% b.w. showed that water load equal to 0.7% b.w. caused significant increase in urine excretion. The rise of diuresis after 10 microg Byetta (exenatide) injection and simultaneous water load of 0.7% of b.w. depended on increase in solute-free water clearance. Thus, exenatide (mimetic of GLP-1) action let us to consider its possible role as component of osmoregulation system in human. This peptide provides high efficiency of renal function in osmotic homeostasis.

[Optimization of respiratory support of elderly patients with pneumonia in the early stages of respiratory failure].

The article provides an assessment of the effectiveness of noninvasive ventilation (NIV) in elderly patients with pneumonia in the early stages of acute respiratory failure (ARF). A total of 83 elderly patients with pneumonia were examined. By the method of randomization, patients were divided into 2 groups. The first group consisted of patients treated by the method of NIV, the second one of patients receiving standard oxygen therapy. The results of the study show that the use of NIV in the treatment of pneumonia, complicated by the ARF in elderly patients resulted in a significant improvement of arterial blood gas as well as hemodynamic and respiratory systems, in comparison with those of patients receiving oxygen therapy.

[Algorithm of examination and treatment of women with mixed urine incontinence].

The examination including filling cystometry, urethral profilometry, uroflowmetry, perineal ultrasonography was made in 62 females aged from 29 to 66 years with a clinical diagnosis of mixed urine incontinence (MUI). Irrespective of the verified diagnosis, the treatment started with conservative methods. Surgical intervention was performed if moderate and severe MUI persisted after conservative therapy. The diagnosis of MUI was confirmed in 66.1% examinees. Stress urine incontinence and hyperactive urinary bladder were diagnosed in 9.7 and 24.2% cases, respectively. The conservative treatment resulted in disappearance of the symptoms of MUI in 43.9%, in partial response in 34.1% patients. 22% patients were treated surgically. Urodynamic and ultrasonic indices helping choice of surgical policy in MUI were not determined. Thus, the principle of staged and comparative assessment of clinical, urodynamic and ultrasound findings improves diagnosis of MUI. Pathogenetic conservative treatment, as the first stage of MUI therapy, provides indications for surgery.

[Orthotopic replacement of the urinary bladder in females].

Orthotopic cystoplasty for various diseases of the urinary bladder was made in 58 females aged 22 to 78 years (mean age 52.5 +/- 5.8 years) in 1996-2005. Surgery was indicated in muscular-invasive cancer of the bladder (n = 35, 60.3%), microcystis (n = 21, 36.3%), bladder atonia (n = 1, 1.7%), vesicovaginal fistula (n = 1, 1.7%). The reservoir was made of iliac segment in 50 (86,2%) patients, of gastric body - in 8 (13.8%) patients. Postoperative complications arose in 7 (12.1%) patients, late complications occurred in 4 (6.8%). Postoperative lethality was not registered, 12 months later 3 (5.2%) patients died of cancer progressiion. Day continence after ileo- and gastrocystoplasty was 93.3 and 87.8%, night - 45.2 and 32.8%, respectively. Urodynamics was satisfactory. Chronic continence occurred in 3 (5.6%) patients. Satisfactory clinical and functional results of artificial reservoir creation in females support advantages of this method of urine derivation. Gastrocystoplasty is a promising method of urinary bladder replacement. It is important to assess function of the lower urinary tract before operation. Reservoir-vaginal fistula is a new kind of urogenital fistulas. It is treated by transvaginal fistuloraphy.

[Testosterone production by tumor tissue in partial androgen deficiency in aged men (PADAM)].

The aim of the study was examination of cause-effect relationships between PADAM, extragonadal production of androgens and high proliferative activity in aged men. The study group included 15 patients aged between 53 and 79 years with prostatic cancer (n = 5), urinary bladder cancer (n = 5) and cancer of the rectum (n = 5). Control samples of tissues of the prostatic gland, urinary bladder and rectum were obtained from dead bodies of men at the age between 18 and 29 years killed in the accidents at the age from 18 to 29 years. Testosterone levels in the tissues of peritumor zone of the prostate, in tumor tissue of patients with cancer of the prostate, urinary bladder and the rectum were higher than in blood serum. In prostatic cancer, testosterone in the tumor tissue was higher than in the tissues of prostatic peritumor zone. The values of Histochemical score AR of the peritumor zone in prostatic cancer patients were higher than those of the control group. It was detected that ER, PR, bcl-2, Ki-67 and p53 in prostatic tissue of young controls were absent while in patients with prostatic cancer these factors were expressed in the peritumor zone. In cancer of the urinary bladder, peritumor zone showed expression of PR, bcl-2, Ki-67 and p53, while no such expression was in the controls. ER, bcl-2, Ki-67 and p53 were registered in the peritumor zone of patients with cancer of the rectum but the controls had neither ER, bcl-2 nor p53 while Ki-67 expression in rectal cancer was higher than in the controls. The results of the study suggest that testosterone production by some tumors and tissues of the peritumor zone accompanied with high proliferative activity and dysregulation of the cell cycle is secondary to PADAM. These changes arise to compensate testicular deficiency and are manifestations of metabolic syndrome (X-syndrome). In this situation immune system fails to utilize all atypical cells.

[Changes in the expression of receptors of steroid hormones in the development of partial androgen deficiency of aging men (PADAM)].

This work is devoted to the vital topic of the influence of partial androgen deficiency of aging men (PADAM) on the development of cells with androgen receptors. The results obtained in this study suggest a conclusion that the production of testosterone by some tumors and tissues of the peritumorous zone, which is accompanied by increased proliferative activity and disturbance of the regulation of the cell cycle, is caused by PADAM. The given changes are directed at compensating for testicular deficiency (in particular at overcoming the androgen-dependent stage of development of androgen-sensitive cells). These changes are a partial manifestation of metabolic syndrome (X-syndrome). The atypical cells, which unavoidably develop during metabolic syndrome, are dealt with by means of the immune system, whose capabilities become less and less adequate in the given circumstances.

[Orthopic plastic repair of the urinary bladder with a gastric segment]. / Ortotopicheskaia plastika mochevogo puzyria segmentom zheludka.

Urinary bladder plastic repair with a gastric segment on a. et v. gastroepyploici dex was made in 22 patients (18 males, 4 females, mean age 58.2 years) from November 2001 to June 2003. Gastrocystoplasty was made in 17 patients after radical cystectomy for urinary bladder cancer, and in 5 patients with neurogenic and small urinary bladder. Three patients have undergone surgery in our modification with a complete cross resection of the gastric body with the lesser curvature. Lethal outcomes were absent. Follow-up for 2-22 months demonstrated that all the patients achieved positive functional results and good quality of life.

[Fluorescent cystoscopy and transurethral electroresection in diagnosis and treatment of patients with invasive cancer of the urinary bladder]. / Vozmozhnosti fliuorestsentnoi tsitoskopii i transuretal'noi élektrorezektsii v diagnostike i lechenii bol'nykh invazivnym rakom mochevogo puzyria.

From 1996 to 2002 we examined and treated 224 patients with invasive cancer of the urinary bladder (ICUB). The examination complex included clinical, laboratory, radiation tests, endoscopic and morphological investigations of the surgical material. The patients received four types of treatment: transurethral resection (TUR) of the bladder wall (n = 102) alone; TUR+MVAC chemotherapy (n = 56); open resection of the urinary bladder only (n = 38); open resection+MVAC chemotherapy (n = 28). In diagnosis of papillary lesions sensitivity of cystoscopy (CS) was 66.6%, fluorescent CS (FCS)--95.2%. Sensitivity in diagnosis of squamous tumors was 33.3 and 91.6%, respectively. The best results were achieved in patients with pT2A tumor invasion depth, G1 differentiation of tumor cells after TUR with adjuvant polychemotherapy (PCT) recurrences in these patients arose by 41.2% less frequently than in patients after TUR only, 5-year survival in patients after TUR+PCT was 83.3%. Thus, FCS improves diagnosis of urinary bladder tumors (sensitivity of CS was 70.0% vs that of FCS--95.0%). In cancer of the urinary bladder the organ can be saved only at stage pT2G1. A method of choice is TUR of the bladder wall with adjuvant PCT.

[Effect of extensiveness of testicular germinoma on the choice of a treatment regimen]. / Vliianie rasprostraneniia germinogennykh opukholei iaichka na vybor taktiki lecheniia.

Complex examination and treatment were given to 282 patients with testicular germ cell cancer. Diagnosis was histologically verified in all cases. Metastases at different sites were identified in 136 (48.2%). Seminoma was treated with telegamma radiation from the ROCUS-M installation; cases of non-seminoma pathology received VAB-6 and BEP regimes. Germ cell cancer staging was facilitated by joint use of up-to-date diagnostic procedures. X-ray examination of organs of the chest was performed in all cases and sometimes supplemented with CT. Ultrasound, CT and MRI were chiefly used for diagnosis of pathologies of the abdominal cavity and retroperitoneal space. Prognosis and chemotherapy regimes were based on tumor stage assessment. After therapy, recurrence-free cases and those with total regression were released from hospital. Oncological follow-up included tumor marker monitoring and dynamic X-ray examination of the chest, abdominal cavity and retroperitioneal space. When metastasis regression was not complete, surgery was indicated, if technically feasible.

[Short-term results of radical cystectomy]. / Blizhaishie rezul'taty radikal'nykh tsistéktomii.

The paper presents the results of 114 radical cystectomies made in 1996-2002. The age of 114 patients (103 males, 11 females) ranged from 37 to 78 years (mean age 57.5 years). Transient cell carcinoma was diagnosed in 81.5% patients. Supravesical urine derivation was conducted by means of ureterocutaneostomy and transureteroureteronephrostomy in 9 (7.9%) patients, ureterosygmoanastomosis--in 43 (37.7%) patients, artificial orthotopic urinary bladder was created in 7 (6.1%) patients of a gastric segment and in 55 (48.2%) patients of the ileum. Postoperative complications were observed in 28 (24.6%) patients, intestinal obstruction being a prevailing complication. Five patients died: 2 of pulmonary artery thromboembolism, 1 of acute cardiac failure, 1 of sepsis and 1 of gastric bleeding. Continent methods of urine derivation were preferred, such as ureterosygmoanastomosis by Mainz-Pouch II and creation of orthotopic urinary bladder of the stomach or of the ileum.

[Short-term outcomes of radical surgery for bladder cancer]. / Blizhaishie rezul'taty radikal'noi operatsii pri rake mochevogo puzyria.

A total of 102 radical cystectomies have been conducted for 1996-2001 (94 males, 8 females, age 37-78 years, mean age 57.5 years). Most of the patients (81.4%) were diagnosed to have transitional cell carcinoma. Supravesical urine derivation was made by means of ureterocutaneostomy and transureteroureteronephrostomy in 7(6.9) patients, ureterosigmoanastomosis--in 41(40.2%), Sigma-rectumpouch--in 1(0.9%) patients, ileocystoplasty, largely by Hautmann and Studer was carried out in 52(51%) patients. Postoperative complications developed in 25(24.5%) patients who often had adhesive ileus. Four patients died: 2 of pulmonary artery thromboembolism, 1 of acute cardiac failure and 1 of sepsis. Methods of continence urine derivation were preferred, such as ureterosigmoanastomosis by Mainz-Pouch II and creation of orthotopic bladder of the ileum.

[Long-term results of endovascular treatment of metastatic renal cell cancer]. / Otdalennye rezul'taty éndovaskuliarnogo lecheniia metastaticheskogo pochechnokletochnogo raka.

The authors analyse the long-term results of treatment of 106 patients with advanced renal cell carcinoma. The patients were divided in two groups. Group 1 (42 patients) included cases with single metastatic lesion. Patients of group 2 (n = 64) had more than one site of metastases. All patients were treated by nephrectomy, embolization with chemotherapeutic agent or arterial occlusion without cytostatic drug except nine patient of group 2, who has undergone chemo and hormonal therapy. The survival according to method at treatment was studies. After occlusion satisfactory results were obtained in cases with single metastasis lesion and also in cases with many sites of metastases. Oily chemoembolization in renal cell carcinoma with distant metastases has given better results as compared with the embolization without chemodrugs. We conclude that endovascular method of treatment is an alternative to the traditional nephrectomy in palliation of renal cell carcinoma.

[The role radiography in assessing the stage of renal cancer]. / Rol' luchevoi diagnostiki v otsenke stepeni rasprostraneniia raka pochki.

The investigation included 421 cases of renal cell carcinoma with metastases of different localization. Tumor advancement was assessed by application of general-view imaging, X-ray, computed and magnetic resonance tomography, ultrasound and osteoscintigraphy. Alterations in the lung were registered in 271 patients (64.4%); metastases into bones--244 (57.9%). Tumor dissemination to retroperitoneal lymph nodes was detected in 166, liver--96 and the brain--6 patients.

[Results of endovascular interventions (embolization and chemoembolization) in the treatment of operable and extensive kidney cancer]. / Resul'taty primeneniia éndovaskuliarnykh vmeshatel'stv (émbolizatsii i khimioèmbolizatsii) v lechenii operabel'nogo i rasprostranennogo raka pochki.

The results of an all-round examination and complex treatment of 323 patients with renal cell carcinoma were evaluated. Locally advanced tumors were diagnosed in 143 (44.3%) and extended ones--in 180 (66.7%). In patients with locally advanced tumor who had undergone nephrectomy after embolization or chemoembolization, 12-, 24- and 36-month survival rates showed no significant difference. In patients with extended renal carcinoma, 2- and 3-year survival was significantly higher after chemoembolization than after standard embolization of the renal artery.

[Diagnostic and treatment experience with amebic lesions of the liver]. / Opyt diagnostiki i lecheniia amebnykh porazhenii pecheni.

The article studies the traits of diagnosis and treatment of 134 patients with amebic affections of liver. It is indicated that on the basis of clinical data it is possible to detect the development of amebic hepatitis or amebic abscess of liver. The most effective methods for treatment are: in case of amebic hepatitis--trans-umbilical injection of amebocytes; in case of amebic abscess of liver--percutaneous puncture of abscess under the ultrasonic sensor control, active aspiration of the content, cavity washing with antiamebic solutions and its trans-umbilical injections.

[The clinical picture of the initial period of intestinal amebiasis]. / Klinicheskaia kartina nachal'nogo perioda kishechnogo amebiaza.

Clinical symptoms of the initial stage of the disease (before the onset of pathognomonic signs of amoebiasis--the formation of ulcers in the colon) have been analysed in 287 patients with intestinal amoebiasis (IA). The following variants of the clinical pattern have been identified: slow-progressing IA (59.2% of the patients examined) and fast-progressing IA (40.8% of the patients examined). In 5 patients with body eight deficit and clinical manifestations of vitamin C and B deficiency the disease assumed a fulminant course. The patients' condition was considered severe or very severe already on the first days of the infection. The results of endoscopic studies (rectoromanoscopy, fiber colonoscopy) demonstrate that the formation of amoeba-induced damages in the colon mucosa takes place by the 6th-14th day of the disease onset.