[Autologous hematopoietic stem cell transplantation as late high-dose consolidation in adult patients with T-cell lymphoblastic leukemias: Results of a Russian multicenter study].

AIM: To analyze the efficiency of the ALL-2009 protocol (ClinicalTrials.gov NCT01 193933) in patients with T-cell leukemias, particularly the role of autologous hematopoietic stem cell transplantation (auto-HSCT) after non-myeloablative BEAM conditioning, followed by maintenance therapy. SUBJECTS AND METHODS: Since 2009, the ALL-2009 study has enrolled 90 patients with T-cell acute lymphoblastic leukemia (T-ALL), the treatment results were assessed in 86 patients: 6 and 28 patients underwent allogeneic HSCT and auto-HSCT, respectively. A landmark analysis was used to compare survival rates in patients who had undergone auto-HSCT and in those who had not. For this, the median time from complete remission to the date of auto-HSCT was determined (the median was 6 months). Then to compare with the auto-HSCT group, only 27 patients who had been in complete remission for 6 months or more were included in a chemotherapy group. RESULTS: The achievement of complete remission in patients with thymic T-ALL (100%) was significantly higher than in those with early (85.7%) or mature (70%) variants. The patients with early and mature T-ALL as compared to those with thymic T-ALL showed high death rates in the remission induction (7.4 and 10% versus 0) and the patients with mature T-ALL had a.higher proportion of refractory forms (20% versus 0). The 5-year overall and relapse-free survival rates in all the T-ALL patients were 66 and 76%, respectively. After auto-HSCT, the risk of recurrence was 0% versus 21% after chemotherapy (p=0.03). The relapse-free survival rates significantly differed in the auto-HSCT and non-auto-HSCT groups: 100 and 66%, respectively (p=0.047). CONCLUSION: The long-term survival rates obtained during this multicenter study in the T-ALL patients treated according to the ALL-2009 protocol, the basis for which is the principle of continuity of cytostatic effects, are exclusively optimistic. Late consolidation with auto-HSCT following non-myeloablative BEAM conditioning, followed by maintenance therapy, considerably reduces the risk of recurrence.

[Experience with continuous epidural anesthesia used in the complex of combined anesthesia at gastropancreatoduodenal surgery].

The purpose of this study was to assess the experience with long-term epidural space administration of 1% lidocaine in combination with general anesthesia. Anesthesia based on the long-term epidural lidocaine administration in combination with general anesthesia versus total intravenous anesthesia based in ketamine and ataralgesia was analyzed. The anesthesia based on the long-term epidural lidocaine administration in combination with general anesthesia was shown to provide steady-state hemodynamic parameters and an adequate antinociceptive protection and to contribute to the early activation of patients.

[Effects of alpha-tocopherol on partial functions of the ischemic kidney].

The experiments on 45 rats and 20 rabbits were made to investigate antiischemic efficacy of alpha-tocopherol in respect of various partial functions of the kidneys compared to its antioxidant activity. It is demonstrated that administration of alpha-tocopherol prior to 30-min heat ischemia arrests activation of membrane lipid peroxidation (LPO) in the tissue of ischemic kidney both in rabbits and rats. Rabbit filtration renal function 1 hour after circulation recovery improved insignificantly, 24 hours after the recovery no difference with the control was registered, while secretory and reabsorption functions of the renal tubules under conditions of pretreatment with alpha-tocopherol significantly improved both in rabbits and rats both 1 hour and 24 hours after ischemia. Estimation of Ca-ATP activity of a microsomal fraction of the cortical substance of the ischemic kidneys has detected alpha-tocopherol induced suppression of LPO in sub-cellular membrane and high activity of this enzyme. Mechanisms of different protective action of alpha-tocopherol on renal glomeruli and tubules are discussed.

[Results of surgical treatment of coral nephrolithiasis].

A total of 98 patients (39 males and 59 females) with coral nephrolithiasis (CN) were divided into 3 groups depending on the variant of surgical treatment. The results were followed up for 5 years. Group 1 and 2 patients have undergone combined low-traumatic open surgery or low-invasive interventions (extracorporeal lithotripsy--ECL or percutaneous nephrometolapaxy--PN), group 3 patients--open surgery (pyelonephrolithotomy or section nephrolithotomy. It was found that the treatment was longest in group 1 and shortest in group 3, complications occurred most frequently in group 3 on section nephrolithotomy, least frequently in group 2. A significant decline of operated on kidney late after the treatment was observed in patients subjected to section nephrolithotomy. Thus, ECL and PN produce positive results in patients with CN (elimination of the stone with a minimal risk of residual concrements) in good long-term function of the operated on kidney.

["I-125 Rapid-Strand" interstitial radiotherapy of localised prostate cancer]. / Interstitsial'naia luchevaia terapiia "125 I Rapid-Strand" localizovannogo raka predstatel'noi zhelezy.

Nikolai Alekseevich Lopatkin, Academician of the Russian Academy of Medical Sciences, has contributed much to development of prostatic cancer (PC) diagnosis and treatment in the Russian Federation. N. A. Lopatkin headed specialists from the Research Institute of Urology who were the first in Russia to introduce into clinical practice the method of interstitial radiotherapy (brachitherapy) of local prostatic cancer (PC). A total of 58 PC patients 42 to 76 years of age were treated. They had stages T1bN0M0 (n = 5), T2aN0M0 (n = 36), T2bN0M0 (n = 11), T3aN0M0 (n = 6). Staging was made by the data of finger rectal examination, transrectal ultrasonography, NMR tomography, radionuclide osteoscintigraphy. Mean PSA was 2.5-36 ng/ml in the size of the prostatic gland 14.96-52.76 cm3. All the patients received neoadjuvant hormone therapy. Four patients one year or more before the radiotherapy had TUR of the prostate. Brachytherapy was made under peridural anesthesia which allowed implantation of 40-120 sources with activity of 0.38-0.35 mCi for 20-45 min. A total dose was 120-160 Gy. Mean hospital stay was 4 days. Spontaneous urination recovered within 6 postoperative hours. The procedure was well tolerated, complications arose on postimplantation day 2-8. We attribute complications to inadequate calculation of the doses at the stage of the method introduction. A short follow-up (3 years) is not long enough to allow conclusions about the efficacy of the method. Within 3 years biochemical recurrence occurred in 4 (6.9%) patients on months 14-26 (stage T2b and 2-T3). Four patients were lost for follow-up. Thus, brachytherapy efficacy depended much on adequate selection of the patients and planning of the procedure by the results of previous volumetry. The procedure is safe and reproducible. The studies will be continued.

[Urodynamics of the upper urinary tracts after ureteroplasty (experimental data)]. / Sostoianie urodinamiki verkhnikh mochevykh putei posle plasticheskikh operatsii na mochetochnike (éksperimental'noe issledovanie).

An experimental study on 12 mongrel dogs was made for assessment of urodynamics of the upper urinary tracts after reconstructive surgery. Ureterohydronephrosis was modelled by cryodestruction, confirmed by x-ray and radionuclide examinations. Urodynamics of the upper urinary tracts was studied by measurements of the intraluminal pressure and at multichannel impedance ureterography under thiopental anesthesia. It was found that reestablishment of normal urine passage after ureteroplasty is not accompanied by urodynamic recovery. Preoperative hyperfunction of the upper urinary tracts and their postoperative hypofunction appeared unfavourable prognostic signs for ureteroplasty outcomes.

[Functional status of urinary tract after plastic surgery of the urinary bladder with a segment of the ileum (experimental study)]. / Funktsional'noe sostoianie mochevykh putei posle plastiki mochevogo puzyria segmentov podvzodoshnoi kishki (éksperimental'noe issledovanie).

Replacement of the gall bladder with an isolated ileal segment was made to evaluate function of the urinary tracts depending on configuration of the created urine reservoir early and late after the operation in dogs. Intestinoplasty of the gall bladder changes parameters of ureteral function. Upper urinary tract urodynamics after ileocystoplasty is characterized by lowering of intraureteral pressure, decreased amplitude of the contractions, high tonicity and motility. The intestinal bladder has the same mean basal pressure at rest but less when full than the control animals. Reflex urination after the bladder reconstruction in subtotal resection was intact. Detubulized urinary reservoir had low intravesical pressure and no spontaneous contraction activity.

[Upper urinary tract hypertrophy of the solitary kidney]. / Gipertrofiia verkhnikh mochevykh putei edinstvennoi pochki.

17 dogs were examined 1 and 3 months, 1-1.5 years after unilateral nephrectomy. It was found that compensatory hypertrophy develops not only in the parenchyma of the remaining kidney but in the upper urinary tracts as well. 1 month after the nephrectomy ureteral activity for urine evacuation enhanced as compared to its preoperative activity. 3 months and 1-1.5 years after the nephrectomy ureteral performance remained elevated. High performance was supported due to increased amplitude of the contractions and their prolongation. Frequency of the contractions reduced. Basal and peristaltic pressure in the ureter, as a rule, rose. Diuretic lazix load 3 months after nephrectomy and more led to higher elevation of the intraureteral pressure. Ureteral wall lock in contraction promoting active urinary transport was observed whereas this locking mechanism before nephrectomy was decompensated even in lower intraureteral pressure. Ureteral hypertrophy was followed by negative effects such as defective generation and conduction of excitation through the ureter, higher incidence of endogenous infection in the urinary tracts.

[Kidney function based on dynamic nephroscintigraphic data in the late period after extracorporeal lithotripsy]. / Funktsional'noe sostoianie pochek po dannym dinamicheskoi nefrostsintigrafii v otdalennyi period posle distantsionnoi litotripsii.

Dynamic nephroscintigraphy (DSG) was performed in 112 patients aged 14 to 76 years who had undergone 1 to 6 sessions of EL for unilateral or bilateral nephrolithiasis. A total of 254 EL sessions on 119 kidneys were performed. DSG was conducted before EL and at least 12 months after elimination of the stone fragments. The improvement of secretory renal function occurred in 68(57%) patients, aggravation was registered in 17(14.3%), unchanged renal function was in 34(28.6%) patients. Out of 17 cases of aggravation EL was responsible for only 3 of them. The others were due to other factors (progressive chronic pyelonephritis, acute pyelonephritis, hematoma, etc.). The conclusion is made that EL is a low-traumatic treatment of urolithiasis which is a method of choice in making decision on therapeutic policy in urolithiasis.

[Extracorporeal lithotripsy of stones in the single kidney]. / Distantsionnaia litotripsiia kamnei edinstvennoi pochki.

The authors used shockwave lithotripsy (SWL) in 130 patients with solitary kidney to crush renal calculi. Valid policy in preoperative drainage may result in a significant reduction of the occurrence of postoperative obstructive complications. It was only 11.5%. A valid choice of sparing regimen of crushing kidney and prepelvic ureter calculi help prevent hematomas, a severe complication of early postoperative period. No cases of this complication were seen in the study. A significant renal function failure in early postoperative period was not recorded. A 2.5--5-year follow-up in 21 patients has found that in 61.9% of patients renal function recovered or remained stable, in 38.1% of patients renal function declined. This was due to deterioration of the underlying disease (chronic pyelonephritis, frequent recurrences of lithogenesis).

[The diagnosis of vasorenal arterial hypertension]. / Diagnostika vazorenal'noi arterial'noi gipertenzii.

Clinical and specific examination of 525 patients with special emphasis on ultrasonic, radionuclide and angiographic procedures, a captopril pharmaco-radiological test, radioimmunoassay of renin in the renal vein and vena cava inferior provided the diagnosis of vasorenal hypertension (VRH) in 65 of them (30 males, 35 females at the age of 18-60). Among etiological factors atherosclerosis, fibromuscular dysplasia, nephroptosis, renal artery aneurysm, aortic arteritis were involved in 40%, 24.6%, 16.9%, 12.3%, 6.2% of the cases, respectively. Chronic renal failure developed in 17% of VRH patients with the disease duration more than 3 years. Also, aspects of evaluation of cardiovascular function with invasive and noninvasive techniques in pre-, intra- and postoperative periods, indications to VRH, basic operative procedures are reviewed. According to WHO criteria, a complete response was obtained in 21 (35.6%), a partial response in 34 (57.6%) patients, no response was registered in 1 (1.7%) case.

[The reasons for the inefficiency of local kidney hypothermia during the temporary discontinuation of their blood supply]. / Prichiny nedostatochnoi éffektivnosti lokal'noi gipotermii pochek pri vremennom prekrashchenii ikh krovosnabzheniia.

Functional changes in the kidney exposed to 1-hour ischemia with surface cooling to +5+7 degrees C (series I) or +16+18 degrees C (series II) were studied in experiments on 50 rabbits and 20 non-inbred rats. In series II animals significant changes in renal function were not registered. In series I cooling there was a marked decrease of creatinine clearance, clearance of osmotic substances and Na-reabsorption during 1-3 days after ischemia. Dynamic scintigraphy with 131I-hyppuran revealed a decline in radionuclide secretion in series I that was more pronounced on day 14. In series II the time course of accumulation and excretion of 131I-hyppuran was almost normal. The worsening of renal function in series I experiments was accompanied with reduction of renal blood flow and activation of cell membrane lipid peroxidation. The investigation of the dependence of renal tissue impedance on the temperature that reflects thermotropic response of cell membrane structural organization showed phasic transitions of membrane lipids at the temperature below +13+14 degrees C. The findings indicate that for prolonged discontinuation of renal blood flow demanding deep kidney cooling, it is necessary to develop specific measures of protection against detrimental action of hypothermia.