[Local immunity indices during the chigain treatment of chronic cystitis in children]. / Pokazateli mestnogo immuniteta pri lechenii khronicheskogo tsistita u detei chigainom.

A total of 117 children with chronic pyelonephritis (CP) aged 4-14 were examined and treated. 57 of them having attendant cystitis received multimodality treatment comprising local intravesicular instillations of chigain controlled by clinical findings, urinalysis, cystoscopy and urinary secretory immunoglobulins SIg A1, SIg A2 and IgG. The drug chigain capable of immune replacement was found to initiate clinical response, positive trends in urinalysis and cystoscopy data, in the levels of secretory urine immunoglobulins. The findings show the need of immune replacement therapy in the complex of modalities to treat children with CP combined with cystitis.

[Surgical tactics in multiple obstructions of the urinary tract in children]. / Khirurgicheskaia taktika pri mnozhestvennykh obstruktsiiakh mochevykh putei u detei.

One the basis of the results of surgical treatment of 84 children the authors identified 5 main groups of multiple obstructions: 1) obstruction of the vesicourethral segment in combination with obstructions of segments located above--37 (44.1%) patients; 2) unilateral obstruction of the ureterovesical and ureteropelvic segments--11 (13.1%) patients; 3) bilateral obstruction of the ureterovesical segments--19 (22.6%) patients; 4) bilateral obstruction of the ureteropelvic segments--11 (13.1%) patients; 5) other variants of obstructions of the ureterovesical and ureteropelvic segments--6 (7.1%) patients. It was established that urodynamic disorders conducive to the occurrence and progress of chronic pyelonephritis in multiple obstructions of the urinary tract in children are determined not only by the nature of congenital morphologic changes in the urodynamic segments, but by the features of their functions, interaction, and mutual influence, which should be taken into account in choosing the tactics of surgical intervention. In combination of obstruction in the vesicourethral segment, as well as in the ureterovesical segments, operative treatment should be started on the vesicourethral segment because urodynamics in the ureterovesical segments in children under 3 years of age may become normal without a surgical intervention on them. Correction of obstruction in the ureterovesical segment facilitates restoration of urodynamics in the ureteropelvic segment in unilateral obstructions, which determines the sequence of the operative intervention.

[The tomitsid treatment of chronic cystitis in children]. / Lechenie tomitsidom khronicheskogo tsistita u detei.

The clinical efficiency of tomicid used in the treatment of childhood cystitis was examined by employing clinical, endoscopic, microbiological, and immunological findings. A total of 140 children were examined. These include 78 with chronic obstructive pyelonephritis without cystitis and 62 with chronic cystitis. The urinary bladder was instilled with reference tomicid solution in 18 children with chronic cystitis during 10-12 days. Tomicid was found to produce bactericidal and anti-inflammatory effects. The immunomodulating effect was shown mainly in young children (aged 1-6 years). The lack of toxic and adverse effects of the drug allows one to recommend for use in pediatric urologic practice.

[The urinary excretion of renal prostanoids in children with chronic obstructive pyelonephritis in vesicoureteral reflux before and after antireflux operations]. / Ekskretsiia pochechnykh prostanoidov s mochoi u detei s khronicheskim obstruktivnym pielonefritom pri puzyrno-mochetochnikovom refliukse do i posle antirefliuksnykh operatsii.

The excretion of renal prostaglandins (PGE, PGF2 alpha, 6-keto-PGE1 alpha and TKB2) was studied in 45 children with chronic obstructive pyelonephritis in the presence of vesicoureteral reflux with account for the disease stage (partial remission--group I; total clinical and laboratory remission--group II) in various periods of surgical corrections of the impaired urodynamics in the area of vesicoureteral segments (in the early postoperative period of 12-14 days after the surgery; in the follow-up period of 6-12 months after the surgery). Preoperative observation of Group I children revealed a significant decrease in urinary PGF2 alpha excretion in the presence of an increase in the circadian TKB2 and 6-keto-PGF1 alpha excretion, whereas the patients from Group II who had normal levels of TKB2 and 6-keto-PGF1 alpha excretion, the levels of PGE and PGF2 alpha were lowered. The retention of sodium was documented in both groups. There was a total recovery of renal sodium and water excretion 6-12 months after the surgery. Children without the urinary syndrome (group II) demonstrated normalization of all secreted prostanoids, whereas in those with pronounced severity of pyelonephritis (group I), the excretion of sodium and diuresis were likely to be provided by hyperproduction of vasodilating sodium and diuretic PGE.

[Urinary microflora and the status of local immunity in children with cystitis]. / Mikroflora mochi i sostoianie mestnogo immuniteta u detei s tsistitom.

Study of the enzymatic and adhesive properties of E. coli isolated from the urine of children with cystitis has demonstrated that P-fimbriae, DNAase- and phosphatase-positive strains with pronounced hemolyzing and metabolic properties mostly occurred in children with associated cystitis and chronic obstructive pyelonephritis. In children suffering from cystitis, the changes on the part of local immunity manifested by the decrease of the content of SIgG in the urine and by the lack of SIgA1 and SIgA2. In children with a disease standing up to 3 years, the synthesis of IgA turned out dominant in the mucous membrane of the neck of the urinary bladder and in the trigone of the bladder, with IgG and IgM output being less intensive. The authors have proved the efficacy of the treatment with tomicide instilled into the urinary bladder of children suffering from cystitis.

[The renin-angiotensin-aldosterone system in children and adolescents with nephrogenic hypertension]. / Sistema renin-angiotenzin-al'dosteron pri nefrogennoi gipertenzii u detei i podrostkov.

Renin-angiotensin-aldosterone (RAA) function was studied in children with secondary hypertension of 2 varieties: vasorenal hypertension (VRH) and arterial hypertension (AH) associated with chronic pyelonephritis. Children with VRH showed RAA activation that depended on the duration of the disease for its markedness. A direct correlation found between ABP, on the one hand, and plasma renin activity and blood aldosterone level, on the other, is evidence of the latter's involvement in VRH pathogenesis. In AH that is due to chronic pyelonephritis, RAA activation was also demonstrated, however, its pathogenetic involvement was only documented in children with urinary passage disorders (vesico-renal reflux), whereas in the rest RAA activation was not a primary cause of BP elevation.